Stories of Diagnosis From Rural Blacks With Diabetes

Abstract

Diabetes has a disproportionate impact on people of color, including Black Americans. An understanding of the perspectives of rural Blacks is needed to design effective programs of diabetes care. The purpose of this study was to examine the experience of being diagnosed with diabetes as described by rural Blacks. This descriptive, exploratory study conducted gender-separated focus groups in 3 rural communities to capture diagnosis perspectives. Findings may be useful to healthcare professionals providing diabetes care to rural Blacks. Participants could describe events surrounding diagnosis with clarity. For many, the diagnosis was not an emotional and/or surprising experience. Participants commonly used expressive or figurative language to relate their stories of diagnosis, and gender differences were noted. Descriptions of diagnosis revealed valuable infor-mation about participants' perceptions of their diabetes.

Culture Brokerage Strategies in Diabetes Education

“…To design a culturally appropriate intervention for diabetes education, Utz and colleagues conducted gender‐separated focus groups among African American women ( n =42) and men ( n =31) with diabetes who lived in three rural communities in central Virginia (Jones et al, 2006; Utz et al, 2006; Wenzel, Utz, Steeves, Hinton, & Jones, 2005; Wenzel et al, 2006). In a group context, the participants felt comfortable sharing their stories about diagnosis and daily management.…”

“…In a group context, the participants felt comfortable sharing their stories about diagnosis and daily management. The researchers noted that participants often used metaphors and commented on the positive influence of spirituality, their reliance on prayer, and their pursuit of conventional as well as alternative modalities for treatment (Jones et al, 2006; Wenzel et al, 2006). Participants reflected on barriers to self‐care, some of which are unique to a rural environment: the lack of specialist physicians and diabetes education programs, a clear deficiency of resources leading to feelings of “living in diabetes darkness” (Utz et al, 2006).…”

“…In a group context, the participants felt comfortable sharing their stories about diagnosis and daily management. The researchers noted that participants often used metaphors and commented on the positive influence of spirituality, their reliance on prayer, and their pursuit of conventional as well as alternative modalities for treatment Wenzel et al, 2006). Participants reflected on barriers to selfcare, some of which are unique to a rural environment: the lack of specialist physicians and diabetes education programs, a clear deficiency of resources Establish ground rules to emphasize a supportive, respectful atmosphere for learning Use metaphors or incorporate stories/testimonies that are culturally appropriate and related to the session content in a meaningful way In a group setting, when possible, collaborate with a respected storyteller in the community to deliver relevant stories/ testimonies Involve community leaders and role models identified by the community Identify strategies to decrease costs of care or lifestyle change Creatively deliver the highlights of evidence-based educational content in everyday language, avoiding the use of technical language or medical jargon Emphasize respect and promote individual/group empowerment by being responsive to priorities of the group and leading an interactive discussion Ask the group or the individual to identify problems in health maintenance or disease management, and apply problem-solving methods mutually Engage in individual goal setting as much as possible, to support, motivate, and activate inner resources for lifestyle change Guide hands-on activities to demonstrate lifestyle changes in reality Use handouts that are straightforward and avoid technical language Provide culturally tailored materials that are appealing and demonstrate/discuss lifestyle change in a relevant and practical manner Offer recommendations for incorporation of home remedies or complementary and alternative products/practices into daily life when applicable and appropriate Involve supportive family members and significant others in the educational sessions Celebrate successes achieved during the sessions and throughout care leading to feelings of ''living in diabetes darkness'' .…”

“…A number of researchers have described the insider viewpoint of African Americans with type 2 diabetes, from both urban and rural settings (Anderson-Loftin & Moneyham, 2000;Blanchard, Rose, Taylor, McEntee, & Latchaw, 1999;El-Kebbi et al, 1996;Maillet, Melkus, & Spollett, 1996;Samuel-Hodge et al, 2000;Utz et al, 2006;Wenzel et al, 2006). Many of the emergent themes were similar across settings: a sense of shock upon diagnosis, lingering powerlessness over the disease, fear of diabetic complications, social and financial drawbacks of the rigid dietary guidelines, and a complicated treatment plan with unrealistic goals set by providers (Blanchard et al, 1999;El-Kebbi et al, 1996;Maillet et al, 1996;Utz et al, 2006;Wenzel et al, 2006).…”

Training of Community Health Workers to Deliver Cancer Patient Navigation to Rural African American Seniors

“…Additional contacts were developed from investigator work with area churches in a previous study. 40,41 …”