Centers for Behavioral and Preventive Medicine, Alpert Medical School, Brown University, Providence, RI, USA.
Cultur Divers Ethnic Minor Psychol. 2010 Oct;16(4):461-7. doi: 10.1037/a0020089.
High Type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, 6 focus groups were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen health care staff interviews were conducted to gain insight into diabetes care in American Samoa. Focus groups and health care staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and health care staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural stigma associated with depression and the importance of establishing rapport before discussing it. Health care providers in American Samoa need training to increase their awareness of depressive symptoms' negative impact on diabetes management in patients who screen positive for depression. All providers must approach the subject in a supportive context after establishing rapport. This information will be used for cultural translation of a community health worker and primary care-coordinated intervention for adults with diabetes in American Samoa, with the goal of creating an effective and sustainable intervention.
美国领土美属萨摩亚的 2 型糖尿病患病率较高，这与饮食和身体活动方面的近期文化变化有关。全球范围内糖尿病合并抑郁症的发病率都很高，这会导致负面的糖尿病结局；但这些数据尚未在美国萨摩亚进行评估。在这项研究中，对 39 名患有糖尿病的美属萨摩亚成年人进行了 6 次焦点小组讨论；讨论内容包括对糖尿病和抑郁症状的看法。还对 13 名医疗保健工作人员进行了访谈，以深入了解美属萨摩亚的糖尿病护理情况。对焦点小组和医疗保健工作人员的访谈进行了翻译、转录，并输入到 NVivo 8 中以方便分析。主题分析表明，糖尿病患者认为抑郁症状会直接导致高血糖。然而，这些症状很少被患者主动提及，并且医护人员表示他们很少在患者中评估这些症状。许多患者和医护人员认为，应对抑郁情绪的最佳方法包括放松、离开困难的情况或进食。工作人员还讨论了与抑郁相关的文化耻辱感，以及在讨论抑郁问题之前建立融洽关系的重要性。美属萨摩亚的医疗保健提供者需要接受培训，以提高他们对抑郁症状对患者糖尿病管理的负面影响的认识，这些患者对抑郁症状进行了筛查。所有医护人员都必须在建立融洽关系后，以支持性的方式来处理这个问题。这些信息将用于翻译美属萨摩亚社区卫生工作者和初级保健协调干预措施，以治疗成年糖尿病患者，目标是创建一个有效和可持续的干预措施。
