Understanding the Roles of Fatalism and Self-Efficacy on Clinical and Behavioral Outcomes for African American with Type 2 Diabetes: A Systematic Review

To evaluate the evidence on the relationship between fatalism, self-efficacy, and clinical and behavioral diabetes outcomes among African American adults with type 2 diabetes and to recommend areas for future work.

Evidence suggests that psychosocial factors including fatalism and self-efficacy are essential for optimizing diabetes outcomes and may be important considerations for reducing health disparities in type 2 diabetes.

A reproducible search using OVID Medline, PubMed, and EBSCOHost was conducted from database creation up to February 2025. Medical Subject Heading terms and key words representing fatalism, self-efficacy, and diabetes were used. Outcomes included: hemoglobin A1c, LDL, Blood Pressure, Self-Care, and Quality of Life. A total of 17 studies were identified, 5 examining fatalism and 12 examining self-efficacy. All 5 fatalism studies demonstrated that fatalism is statistically significantly related to self-care behaviors and HbA1c, however this relationship may be impacted by other psychosocial and social risk factors. Among the self-efficacy studies, 11 demonstrated statistically significant relationships between self-efficacy and one or more clinical and behavioral outcomes including HbA1c, diet, physical activity, medication adherence, blood glucose testing, and quality of life. All studies were cross-sectional analyses. Given the small number of studies focused on fatalism and the largely correlational results for self-efficacy, there is a need for more targeted research to understand contributors to and moderators of the influence of the factors on outcomes.