Exploring Religiosity, Spirituality, Coping, and Resilience Among African-Americans with Diabetes

Background and Purpose: Self-care of diabetes is burdensome, due to the complexity of maintaining and managing daily self-care activities, including exercise, diet modification, and medication adherence. For persons learning how to re-engage in managing personal health conditions, the challenges for maintaining diabetes self-management practices are even more complex.  Questions remain about how clinics and social workers will support diabetes self-management behaviors for populations who do not have experience accessing clinic services for routine care, hold little experience in daily management, and are in the process of learning how to use newly acquired health insurance (Chlebowy, Hood, & Lajoie, 2013; Rovner, Casten, & Harris, 2013; Trief et al., 2013). The aims of the present qualitative study were to explore the role of religion and spirituality in diabetes self-management practices for formally homeless African Americans who newly enrolled in health insurance and understand the foundations for resilience in diabetes care.

Methods: Participants were recruited from an urban county clinic in California that specializes in providing treatment to homeless and vulnerable populations.  The clinic offers integrated medical and psychiatric services. Qualitative semi-structured face-to-face interviews were conducted with 42 African American men and women who were older than 18 years, reported previous homelessness for at least three years, received a diagnosis of diabetes from the clinic, and had recently enrolled in Medicaid. The semi-structured interview questions were standardized. Participants were asked open-ended questions such as: “Describe the role of religion or spirituality plays in your life? Describe the ways your faith have helped you manage your illness? What beliefs or practices help you manage your illness?” Questions were worded to elicit a narrative-style response, and the interviewer was instructed to probe or clarify responses when appropriate. All interviews lasted between 1 – 1.5 hours, audio-taped, and transcribed verbatim. The semi-structured interviews were coded into meaningful categories or themes and analyzed using ATLAS.ti (version 7.0).

Results: Participant ages ranged between 28 and 71 years (mean age = 53.5 years).  Women represented the majority of the sample (n = 23; 55%). On average, reported annual incomes were less than $9,400 and more than half were high school graduates (55%). All the participants were formally homeless; however, many were fairly familiar with a form of a structured religious community. Participants’ religiosity and spirituality strongly influenced diabetes management practices.  Nine participants reported that their diabetes and other comorbid conditions increased their faith in God. Five resilience themes emerged as cornerstones for coping with diabetes.

Conclusions and Implications: Most participants engaged in religious practices that supported his or her diabetes self-care. Few participants blamed religion or his or her connection to spirituality on times when diabetes self-management activities faltered. This research focuses on a population not commonly thought to hold religious preferences, views, or utilize spirituality as a mechanism to maintain healthy practices.  The study findings highlight the importance of spiritual and religious beliefs and coping strategies in diabetes self-care activities.  Future research should focus on determining how providers integrate patients' beliefs into clinical and social service practice interventions.