Research Department, Southcentral Foundation, Anchorage, AK 99508, USA.
J Community Health. 2013 Feb;38(1):86-94. doi: 10.1007/s10900-012-9585-5.
Type 2 diabetes is a worldwide health problem that has reached epidemic proportions in some communities. Alaska Native and American Indian (AN/AI) people are disproportionately diagnosed with type 2 diabetes and incidence is increasing in many Alaska communities. Developing effective interventions requires understanding the social and psychological factors that impact effective management of diabetes, yet little is known about these factors in AN/AI communities. The objective of this study was to explore perceived psychosocial needs and barriers to management of diabetes among AN/AI adults with type 2 diabetes receiving care at the Alaska Native Primary Care Center (ANPCC) to inform programmatic efforts and potential future research. We conducted three focus groups and five interviews with 13 AN/AI adults with type 2 diabetes. Interview and focus group questions elicited perceived factors that affect management of diabetes, with a focus on the psychological, social and spiritual impacts of diabetes. Data were transcribed, coded and analyzed using thematic analysis. Key themes that emerged from these data included resources and roadblocks, as well as turning points in the trajectory of diabetes. Resources are factors with a perceived positive impact on management of diabetes, including: (1) knowledge and education about diabetes, (2) social support from other people with diabetes, (3) spirituality, and (4) self-efficacy. Roadblocks are factors with a perceived negative impact on management of diabetes and include: (1) self-reported lack of knowledge about nutrition and diet, (2) social difficulties caused by dietary restrictions, and (3) co-morbid medical conditions. Finally, turning points are experiences described by participants as having transformed roadblocks in resources and thus facilitating improvement in the management of diabetes. Future programmatic interventions to improve management of diabetes with this population should focus on improving dietary education and social support opportunities for newly-diagnosed individuals. Also, educational and support opportunities for family members and friends of individuals with diabetes should also be offered to facilitate understanding and support of their loved ones' management of diabetes, especially with regard to dietary restrictions in social settings. Efforts should also focus on strengthening newly-diagnosed individuals' self-efficacy and providing ongoing support as individuals progressively adjust to the illness over time and make behavioral changes. Future research with this population should explore the effects of family support groups and the possibility of Web-based or other alternative interventions for improving psychosocial health and management of diabetes efforts.
2 型糖尿病是一个全球性的健康问题，在某些社区已经达到了流行的程度。阿拉斯加原住民和美洲印第安人（AN/AI）人群被诊断出患有 2 型糖尿病的比例不成比例，而且许多阿拉斯加社区的发病率正在上升。要制定有效的干预措施，就需要了解影响糖尿病有效管理的社会和心理因素，但对于 AN/AI 社区的这些因素知之甚少。本研究的目的是探讨接受阿拉斯加原住民初级保健中心（ANPCC）护理的 2 型糖尿病 AN/AI 成年人对糖尿病管理的感知心理社会需求和障碍，以为项目工作和潜在的未来研究提供信息。我们对 13 名患有 2 型糖尿病的 AN/AI 成年人进行了三次焦点小组和五次访谈。访谈和焦点小组问题引出了影响糖尿病管理的感知因素，重点关注糖尿病对心理、社会和精神的影响。数据通过主题分析进行转录、编码和分析。这些数据中出现的主要主题包括资源和障碍，以及糖尿病轨迹上的转折点。资源是对糖尿病管理有积极影响的因素，包括：（1）糖尿病知识和教育，（2）来自其他糖尿病患者的社会支持，（3）精神信仰，以及（4）自我效能。障碍是对糖尿病管理有负面影响的因素，包括：（1）自我报告缺乏营养和饮食知识，（2）饮食限制引起的社会困难，以及（3）合并的医疗状况。最后，转折点是参与者描述的经历，这些经历改变了资源中的障碍，从而促进了糖尿病管理的改善。未来针对这一人群的方案干预措施应重点改善新诊断个体的饮食教育和社会支持机会。此外，还应为糖尿病患者的家庭成员和朋友提供教育和支持机会，以促进他们对亲人糖尿病管理的理解和支持，特别是在社交场合中对饮食限制的理解和支持。努力还应侧重于增强新诊断个体的自我效能，并随着时间的推移，随着个体逐渐适应疾病并改变行为，为他们提供持续的支持。未来针对这一人群的研究应探讨家庭支持小组的效果，以及网络或其他替代干预措施改善心理社会健康和糖尿病管理努力的可能性。
