Graduation Year

2004

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Anthropology

Major Professor

Angrosino, Michael V.

Keywords

glucose control, health education, health communication, minority health, women's health

Abstract

Prescribed self-management behaviors have been found to be important factors affecting the rates of morbidity and mortality in multiple medical conditions including chronic diseases such as diabetes, a condition that disproportionately affects high health risk populations such as African Americans. This study focused on understanding health behaviors, beliefs, and associated factors such as support systems and access to care that played a role in diabetes self-management and glucose control. The study also explored diabetes self-management education and its role in diabetes self-management. The research conducted in Pinellas and Hillsborough counties in Florida, included twenty-five African American women between the ages of forty-six and eighty-seven, with self-identified diabetes mellitus (type 2 diabetes).

The study also included seven diabetes self-management educators consisting of nutritionists, a nurse educator, physicians, and an exercise physiologist--key members of the diabetes self-management team. Additionally, five diabetes education programs were observed. Methods included semi-structured qualitative interviews, with direct and participant observation of the Diabetes Intervention Prevention Program (DIPP), the St. Petersburg Free Clinic Diabetes Program, and the Morton Plant Meese/Joslin Diabetes Program in Pinellas County. Hillsborough County sites included the USF Diabetes Program, and University Community Hospital's Diabetes Care Program. Site selection included a cross-section of program types: non-clinic/community-based, community-based clinic, hospital-based, and university clinic-based. The study also utilized a thirty-nine question survey designed to elicit information about self-management beliefs and behaviors.

Results revealed several self-management behavioral variables affecting glucose control: (1) nutritional/dietary changes, (2) exercise, (3) medication use, (4) blood glucose monitoring, (5) physician-patient interaction, (6) support systems, and (7) patient education/knowledge. Results also identified access to care as a contributor to self-management. Two models of diabetes self-management emerged from the findings: a model of balanced self-management held by the diabetes educators and self-management programs, and a model of Interruption practiced by the women. Recommendations highlighted the need for the awareness of socio-cultural factors affecting self-management, the elimination of barriers affecting access to care, improvement in physician-patient interaction, provision of culturally aware patient education, and stronger community and family support systems.

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