Akbar Heena, Gallegos Danielle, Anderson Debra, Windsor Carol
School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Australia, Brisbane, Queensland, Australia.
Pasifika Women's Alliance Inc (PWA), Brisbane, Queensland, Australia.
Health Soc Care Community. 2022 Sep;30(5):1988-1999. doi: 10.1111/hsc.13580. Epub 2021 Sep 27.
Community-based participatory research using culturally appropriate talanoa approaches provided the framework to explore diabetes self-management of Australian Pacific Islander (API) women living with type 2 diabetes in South-East Queensland. Data collection included interviews with key informants (21), in-depth interviews with API women with diabetes (10), talanoa group discussions (7) and monthly steering committee meetings. Using an interpretive-constructionist lens and the interpretations of community members, four cultural constructs in diabetes self-management emerged: self-identity, spirituality, stigma and denial, and structural factors. Self-identity connected the women to their Pacific heritage that framed their collective roles as primary caregivers in the community. This gave the women a strong sense of belonging and helped maintain cultural, family and relational connections which were important for their day-to-day management of diabetes. Although spirituality through religion supported the women to cope with their diabetes a total reliance on God resulted in disengagement with self-care. Shame associated with disclosure also prevented effective self-management. Finally, structural factors such as access to healthcare, poor health literacy and cultural barriers associated with obesogenic environments impeded women from seeking appropriate diabetes care. However, family and community were critical in ensuring women were supported with their diabetes self-management. The findings highlight the importance of engaging families in healthcare planning decisions in the development of culturally responsive models of diabetes support care for API women with type 2 diabetes.
基于社区的参与式研究采用符合文化习惯的对话方法，为探索生活在昆士兰州东南部的澳大利亚太平洋岛民（API）2型糖尿病女性的糖尿病自我管理提供了框架。数据收集包括与关键信息提供者的访谈（21次）、对患有糖尿病的API女性的深入访谈（10次）、对话小组讨论（7次）以及每月的指导委员会会议。运用解释建构主义视角和社区成员的解读，在糖尿病自我管理中出现了四种文化建构：自我认同、灵性、耻辱与否认以及结构因素。自我认同将这些女性与她们的太平洋传统联系起来，这种传统塑造了她们在社区中作为主要照顾者的集体角色。这给予了女性强烈的归属感，并有助于维持对她们日常糖尿病管理很重要的文化、家庭和人际关系。尽管通过宗教的灵性支持这些女性应对糖尿病，但完全依赖上帝导致她们脱离自我护理。与披露相关的羞耻感也阻碍了有效的自我管理。最后，诸如获得医疗保健的机会、健康素养低下以及与致胖环境相关的文化障碍等结构因素，阻碍了女性寻求适当的糖尿病护理。然而，家庭和社区对于确保女性在糖尿病自我管理方面得到支持至关重要。研究结果凸显了让家庭参与医疗保健规划决策在为患有2型糖尿病的API女性制定具有文化响应性的糖尿病支持护理模式中的重要性。
