Paper
Friday, 21 July 2006
This presentation is part of : Models and Strategies to Care for the Chronically Ill
Symptom-Focused Diabetes Care for Older African American Women with Type 2 Diabetes: Evolution of a Conceptual Model
Anne Skelly, RN, PhD, ANP, CS, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Learning Objective #1: The learner will be able to describe the role of symptoms as it relates to diabetes management and health outcomes.
Learning Objective #2: The learner will be able to describe how ethnic and cultural perceptions and beliefs can be integrated into culturally-sensitive approach to diabetes management.
Diabetes is a major problem in the African American community. The prevalence of diabetes increases with age and older African Americans with diabetes experience higher rates of complications and greater disability than older whites with diabetes. This is especially true for older African American women living in rural areas who may also face economic hardships adding to the burden of managing diabetes.  While diabetes education is considered to be the mainstay of treatment for diabetes, ethnic and cultural differences exert powerful influences on the acceptability, adoption and sustainability of healthy self-care behaviors and need to be incorporated into the plan of care for change to occur. We developed and pilot tested a conceptual model for older African American women with type 2 diabetes based on the individual’s symptom experience and incorporating cultural and age-related factors that affect diabetes self-care management. A key premise of this model is that an individuals perception of symptoms directs their management of that symptom and thereby, health outcomes. Participants in the pilot intervention showed statistically significant improvement in their medication, diet, home glucose monitoring self care, perceptions of quality of life and distress from symptoms. Participant satisfaction with the intervention was high. Based on pilot data, the model was re-conceptualized and two new instruments to measure different domains of symptom distress and symptom knowledge developed and pilot-tested. The revised model is presently guiding a larger RCT of the symptom intervention compared to an attention control intervention. In this paper, we present our work as an example of the scholarly process involved in the development of culturally-sensitive nursing knowledge.

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