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This study examined appraisal of perceived threat of diabetes and the relation to adherence to self-management behaviors in uninsured Appalachians receiving care at a free clinic. Participants were at least 18 years of age, English-speaking, and uninsured. Participants followed recommendations for taking prescribed oral medications an average of 6.6 days/week, diet 4.1 days/week, and exercise 2.9 days/week. Relationships were found between appraisal and self-management variables. Diabetes was perceived more as challenging than threatening. Although part of a recognized group experiencing health disparities, adherence behaviors did not differ from those of other patient populations. Appraisal of diabetes is an important issue when discussing adherence with patients. Interventions targeting the perception of diabetes as a challenge rather than a threat would contribute to the understanding of adherence. Developing this characterization, rather than emphasizing the poor physiological outcomes associated with diabetes, could improve self-management behaviors and diabetes control.