“I Had to Rediscover Our Healthy Food”: An Indigenous Perspective on Coping with Type 2 Diabetes Mellitus

Abstract

Type 2 Diabetes Mellitus (T2DM) is disproportionally prevalent among the Bedouin minority in Israel, with especially poor treatment outcomes compared to other indigenous groups. This study uses the perspective of the Bedouins themselves to explore the distinct challenges they face, as well as their coping strategies. The study is based on an interpretive interactionist analysis of 49 semi-structured interviews with Bedouin men and women. The findings of the analysis include three themes. First, physical inequality: the Bedouin community’s way of coping is mediated by the transition to a semi-urban lifestyle under stressful conditions that include the experience of land dispossession and the rupture of caring relationships. Second, social inequality: they experience an inaccessibility to healthcare due to economic problems and a lack of suitable informational resources. Third, unique resources for coping with T2DM: interviewees use elements of local culture, such as religious practices or small enclaves of traditional lifestyles, to actively cope with T2DM. This study suggests that there is a need to expand the concept of active coping to include indigenous culture-based ways of coping (successfully) with chronic illness.

Comparing Patient Perspectives on Diabetes Management to the Deficit-Based Literature in an Ethnic Minority Population: A Mixed-Methods Study

“…Instead, most DAPI participants exhibited strong support for patient agency and proactive diabetes self-management, rooted in cultural-religious maxims. This is consistent with studies among other populations with high levels of religiosity that have found religion/spirituality to be important to patients’ lives and diabetes management, without replacing personal responsibility for self-care [ 42 , 45 , 46 , 47 ].…”

“…Particularly for women, greater family obligations and responsibilities reduced the time available for engaging in physical activity and other healthy behaviors. Studies conducted in collectivist societies have suggested that in such contexts, family-/community-targeted behavioral interventions might be more effective than individual-targeted interventions [ 37 , 41 , 42 , 43 , 44 ]. Approaching healthy lifestyle behaviors as a social obligation (inclusive of all family members), rather than an individual obligation for a person with diabetes, may benefit from the key cultural role women play in managing the family (e.g., which could be extended to organizing family exercise groups).…”

“…Likewise, a literature review on diabetes among Arabs in Israel identified no interventions targeting the SDOH [ 15 ]. However, a recent qualitative study among Arabs with diabetes in one region of Israel, which broke from the deficit-based approach and was centered around patient perspectives, emphasized the centrality of the SDOH to patient concerns [ 42 ]. The current and previous [ 37 ] DAPI study publications corroborate this finding and extend it by including a cross-national sample of Arab communities, and quantitatively confirming the generalizability of the qualitative findings in a larger, representative patient sample.…”

Psychological Network of Stress, Coping and Social Support in an Aboriginal Population

“…As another example, instead of a Western-centric stress-coping model (which focuses on individual coping behaviours), American Indians’ and Alaskan Natives’ coping strategies include connection to community, spirituality, traditional healing practices and enculturation, and are better understood through an “Indigenist stress-coping model” [ 100 ]. These successful culture-based ways of coping are employed by Indigenous peoples all across the world, such as Bedouin peoples in Israel, who have relied upon (and “rediscovered”) traditional healthy foods to cope with chronic illness [ 101 ]. Social support has also been considered one of the main psychosocial determinants of Indigenous people’s ability to thrive despite largely unfavourable circumstances [ 102 , 103 ].…”

“…However, previous studies have investigated the processes of stress, coping and social support in Indigenous populations worldwide qualitatively [ 101 ] or quantitatively with latent variables models [ 102 ]. Another contribution of our study is that the use of network psychometric models can inform the conditional associations established between behaviours, cognitions and emotions (item scores), instead of the associations established between latent traits (total scores, subscale scores and factor scores).…”