African American Women's Perceptions of Diabetes

Purpose:  In the United States, diabetes is more prevalent in African Americans than it is in Whites.  African Americans with diabetes are at higher risk than Whites for negative consequences such as amputation, renal failure, and death.  Diabetes is due both to environmental and genetic factors, with Type 1 more heritable (88%) than Type 2 (26%).  Kleinman’s framework for developing explanatory models of illness examines how laypeople view diseases by looking at their views of etiology, consequences, course of illness, and treatment.  Prior research with predominantly White participants found laypeople perceived having a family history of diabetes as less threatening than a family history of heart disease or cancer, but little is known about how African Americans view family history of diabetes.   The purpose of this study was to explore African American women’s perceptions of the etiology of diabetes, as well as the implications of these perceptions for disease prevention and treatment.

Methods:  In thirty-two semi-structured interviews, African American women from a Midwestern metropolitan area were asked about collection of family health history information and family history of diseases.  A list of diabetes-related codes was developed to capture aspects of the disease that were biomedical (e.g. treatment with insulin) or sociocultural (e.g. the social construction of diabetes as “sugar”). Transcripts were coded using Atlas.ti qualitative software.  These codes were then analyzed to identify important themes.

Results:  Participants held nuanced views about the roles of genetics and lifestyle in the development of diabetes.  Diabetes was believed to “run in the family” due to both shared genetic inheritance and shared health behaviors.  Attitudes and reactions to diabetes ranged from shame to openness.  Participants described vivid examples of the consequences of diabetes among friends and family members, including amputation, coma, and death.  Several people discussed how the conception of diabetes as “sugar” among older African Americans could lead to confusion in younger family members.  Prevention was seen as possible through changes in diet, increased exercise, and achieving or maintaining a healthy weight. 

Implications: Participants demonstrated a broad understanding of what it means for a disease to “run in the family”; they understood that diabetes has both genetic and behavioral causes. Diabetes was a feared disease among many participants, which suggests they may be highly motivated for prevention. Interventions should take into account the cultural context, including social construction of diabetes and issues related to family communication. Future research for social chance should investigate family-based prevention strategies focused on dietary change, which may be especially effective in this population.