Sugar in the Blood: The Meanings of Diabetes among Newly Arrived Filipinos in the United States

Serafica, Reimund

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the United States, particularly among immigrant populations. Primary prevention programs for diabetes must be designed to address the cultural beliefs of the populations they target. Little research has investigated the beliefs of those immigrants who do not have T2DM. Filipinos are at high risk for developing diabetes, especially T2DM. There is a need to highlight in improving diabetes management and prevention with efforts in primary prevention among those at risks for developing T2DM.

Purpose: The purpose of this qualitative ethnography study was to explore the knowledge, perception, and beliefs of newly arrived Filipino immigrants about T2DM, healthy lifestyle, and perceived barriers to healthy lifestyle.

Theoretical Framework: The theoretical framework for this study was based on Leventhal's illness representative model. This illness representation model was developed in an attempt to understand people's cognitive representation of the nature of the threat. It was the illness representation model of self-regulation that provided the understanding of perceptual factors in response to a wide variety of chronic illnesses such as T2DM.

Research Design: This qualitative descriptive ethnography study used face to face interviews, which were conducted using an interview guide. No further interviews were conducted after data were saturated. The data sources were field notes and audio-recorded interviews, which were transcibed verbatim by the researcher. A sample of newly arrived (less than six years in United States) first generation Filipino immigrants (N=46), not diagnosed withT2DM, living in southeastern part of United States was used in the study. This study complied with the protocol for human subjects protection as obtained from the institutional review board. Content analysis was conducted using the NVivo 8 software. Prior to analyses of the transcripts, each transcript was read at least twice and compared to the recordings to ensure accuracy and completeness. To ensure trusthworthiness, selected transcripts were reviewed and coded by two experience qualitative ethnography researchers to ensure intercoder reliability.

Results: A significant number of the participants had little knowledge and few beliefs about T2DM. The perceptions of T2DM were varied, but several beliefs were widely held: (a) T2DM is a “sugar disease” that is based on sweet food intake, (b) T2DM can result from several factors, including strong emotions and lifestyle characteristics (an unhealthy diet, not taking care of oneself), (c) beliefs about strong emotion and the importance of blood are related to diabetes causes, symptoms, and treatment, and (d) a major and undesirable outcome of T2DM is weight gain. One of the major findings in this study was the low diabetes literacy among the participants.

Conclusions/Implications to Nursing: Although immigration brings opportunities, there are also numerous risks. Some of the diabetes beliefs that this study delineates provide anchors for future culturally appropriate intervention programs for recent Filipino immigrants. Immigrants with low diabetes literacy may have lower awareness of the disease condintion, which may have a negative impact on their disease prevention behaviors. Migratory background is also an important factor in influencing beliefs about disease prevention in a diverse community. These results provide information for the design of health programs within the context of global health and nursing for the prevention of T2DM.