African Americans’ Culturally Specific Approaches to the Management of Diabetes

Abstract

Spirituality is an important multidimensional cultural resource and coping strategy used by many African Americans for managing chronic diseases such as diabetes. Yet, few studies examine meaning and interpretation of colloquial terms frequently used for coping within the context of a community culture. We designed an interpretive qualitative study to gain a deeper understanding of a colloquial phrase, “I ain't claiming it,” used among Project SuGar research participants when discussing diabetes. Thematic analysis revealed two major themes, Acknowledgment and Denial, as coping mechanisms through an active or passive relationship with God. Sub-theme of acknowledgment was presented as front seat driver and sub-theme for denial of the disease presented as back seat driver. These meanings encompass a range of culturally specific coping strategies for self-management that health providers should consider and implement as part of providing patient-centered care to enhance better outcome strategies.

Ethnic Disparity in Diabetes Self-Management Class Utilization, Behavioral Risk Factors Surveillance System 2012

“…This information can guide demographics-customized design, implementation, and adoption of effective diabetes self-management classes by a greater percentage of individuals from diverse backgrounds. Hispanics, and possibly other high-risk populations, are in particular need of increased class utilization and would likely benefit from increased engagement and accessibility of multilingual, culturally appropriate healthcare teams, mobile technology, and community resources to enhance their engagement in diabetes self-management education [15,16]. BRFSS data are obtained by self-report and, as a result, subject to recall bias as well as under and over reporting.…”

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…Adherence with medications, diet, foot care, self-monitoring of blood glucose (SMBG), and physical activity in African Americans with T2D can be significantly improved with culturally targeted selfmanagement programs in the community (e.g., providing education, stress management, and coping skills in urban church settings) (171). Another technique is to understand culturally specific coping strategies for diabetes self-management among African Americans, particularly "acknowledgement" (subtheme: "front-seat driver") and "denial" (subtheme: "back-seat driver") as part of an active or passive relationship with God (172). In another study, culturally sensitive cognitive interviewing techniques, are useful engagement tools for African American women with T2D; these tools include concurrent and retrospective think-aloud when answering questions, repeating and paraphrasing questions, and follow-up probing questions (173).…”

Help for Osteoarthritis Pain in African American Elders (HOPE)

“…1. Spirituality in most AAs greatly influences all dimensions of life, including managing chronic diseases (Newlin, Knafl, & Melkus, 2002;Spruill, Magwood, Nemeth, & Williams, 2015).…”

“…You have to claim it to have it" (Fiargo et al, 2004). Other chronic disease research with AAs also offer the same perspective about "claiming" a health condition (Spruill et al, 2015). As a spiritual mechanism, refrain from claiming OA is related to the scriptures found in Proverbs 23:7a (KJV) that says "For as he thinketh in his heart, so is he…".…”

“…Yet if older AAs do not claim or believe they have OA, they may be less likely to participate in selfmanagement and seek professional care and instead rely only on prayer and faith. Some, on the other hand, suggest using this deeply embedded cultural belief to improve self-management rather than to stigmatize populations (Spruill et al, 2015). Still, as Levin et al (2008) points out, reliance on prayer and faith may hinder AAs from seeking appropriate medical care.…”