Abstract
Illness perceptions, which are likely influenced by patients’ cultural contexts, are associated with disease self-management and adherence. African American patients perceptions of type 2 diabetes is not well understood and no known studies has used a comprehensive evidence-based theoretical framework to explore what AAs with type 2 diabetes know, believe, and think about type 2 diabetes. Understanding perceptions of an illness shared by a group of people will be useful in developing culturally-appropriate interventions targeted to the needs of the community. The purpose of this study is to explore African Americans’ perceptions of type 2 diabetes based on the common sense model of illness and self-regulation. Using a phenomenology qualitative approach and purposive sampling, 40 African American men and women, age 45–60 years old with diagnosed type 2 diabetes at least one year prior, and who took at least one prescription diabetes medication, participated in six semi-structured 90-minute focus groups conducted in a private space. Qualitative content analysis was conducted to explore African Americans beliefs about type 2 diabetes. Participants expressed that historical issues, e.g., slavery, healthcare providers, the government, and God influenced how they developed diabetes. Participants reported a loss of autonomy, a change of their identity as an employee, a social individual and sexual person, as well as anger and frustration due to having diabetes. Diabetes made the African American family bonding experience of eating difficult, and the disease diminished their cultural experiences. Concerns about diabetes ranged from fear of death and amputations to the inability to prevent the disease among their children/grandchildren. Participants perceived that medications, faith in God, and positive thinking about survival helped control diabetes. Conclusions: Improved diabetes self-management and medication adherence may depend on the meaning African Americans attach to diabetes, available psychosocial support for managing diabetes, and African Americans experience with diabetes.
Highlights
Over the past several decades, the prevalence of diabetes among adults has increased, with about one-third of the United States population affected by diabetes.[1]
Our current study examines how patients currently diagnosed with type 2 diabetes view their illness, as their illness perceptions are likely to be associated with their medication-taking behaviors and diabetes self-management efforts
Adults 45 years old are more frequently diagnosed with type 2 diabetes. [37, 38] The inclusion criteria were self-identified English-speaking African American/Blacks, self-reported type 2 diabetes diagnosed by a health provider at least 1 year prior, and self-reported use of oral diabetes medications
Summary
Over the past several decades, the prevalence of diabetes among adults has increased, with about one-third of the United States population affected by diabetes.[1]. Medication nonadherence (not taking medicines as prescribed by a healthcare provider) [6] is a complex behavior that is prevalent among AAs with type 2 diabetes (12% lower adherence compared to white non-Hispanics).[7] To help patients improve adherence behavior, health care providers need to be aware of how different cultural contexts influence patients’ knowledge and beliefs about diabetes. [8, 9] Studies have shown that illness perceptions influence whether patients take their medicines or not, and should be taken into account in designing adherence interventions.[10,11,12] AA patients’ perception of type 2 diabetes is not well understood, and to date, no known studies have used a comprehensive evidence-based theoretical framework to explore what AAs with type 2 diabetes know, believe, and think about type 2 diabetes. 2000, have called for qualitative studies that use comprehensive theories, since these type of studies are limited among AAs. [13] This qualitative study uses Leventhal’s common sense model (CSM) [14, 15] as the guiding framework to explore AAs’ perception of diabetes
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