Saturday, October 31, 2009: 3:35 PM
Jane A. Tiedt, RN, CDE
Department of Nursing, Gonzaga University, Spokane, WA
Rebecca S. Sloan, PhD, RNCS
Family Health Department, Indiana University School of Nursing, Indianapolis, IN
Learning Objective 1: explore cross-cultural barriers to diabetes self-management from the perspective of Native Americans in the inland Northwest.
Learning Objective 2: describe how the study results have implications for providing culturally sensitive healthcare.
Diabetes disproportionally affects Native Americans. Nurses have long been concerned about social justice and the healthcare needs of the underserved and play a key role in addressing this health disparity. Gaining a deeper understanding of individual experiences of health and illness from a cross-cultural perspective can help improve patient care. This is particularly true for patients trying to manage the complexities of diabetes self-management. Most studies on diabetes self-management in Native American populations have focused on tribes in Arizona and
New Mexico. Little is known about the experiences of living with diabetes for the Columbia Plateau tribes. The purpose of this pilot study was to explore the experiences of tribal members living with type 2 diabetes using a Heideggerian hermeneutic framework.
The sample for the study was tribal members with type 2 diabetes living in eastern Washington and northern Idaho. Participants were recruited through the local diabetes educator using purposive sampling. Participants took part in non-structured in-depth interviews lasting from 60-90 minutes. Interviews were recorded and transcribed verbatim; pseudonyms were used to protect confidentiality. Data analysis consisted of three-steps: ‘in the moment” analysis at the time of the interview, reading and re-reading each transcript to identify emerging themes and analytical interpretations across and between narratives for themes and relationships.
The major themes uncovered were perseverance, valuing tribal family and traditions, and flawed communication. The results of this pilot study highlight the importance of family, community, and traditional beliefs in balancing the daily challenges of diabetes. In addition, historical trauma influenced how they managed their diabetes and their interacting with the healthcare system. Communication gaps emphasized flawed efforts to provide culturally sensitive healthcare. The tribal community needs to be collaborative partners in their care and this culturally-sensitive healthcare should be grounded within their worldview rather than through a Euro-American lens.
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