How African American families can talk about diabetes

African Americans, who have a high risk of type 2 diabetes, may often share myths and misconceptions about the disease from one generation to the next, researchers say.

To understand how family experiences influence risk and management of the disease, researchers interviewed parents and adult children of 20 African American families with strong histories of type 2 diabetes.

The interviews, which focused on diagnosis, physical activity and nutrition, resources for managing the disease, and family support and communication, allowed researchers to dig deeper into family dynamics.

“We wanted to get into the meanings and nuances within the family culture to identify some malleable targets we can work with,” says Tera Jordan, an associate professor of human development and family studies at Iowa State University. “By understanding the meanings people have around food and nutrition, we might find ways they can make change.”

The study in Global Qualitative Nursing Research identifies two primary themes—family interactions and intergenerational openness—that shape what younger generations know and do about the disease.

The findings provide insight that may help doctors and nurses counsel African American patients, says lead author Brianna Routh, assistant professor at Montana State University, who was part of the research team while a graduate student at Iowa State.

“Some family interactions could directly inform an individual’s behaviors and ability to manage their diabetes, so it is important for medical professionals to ask questions to better understand how these interactions might support or hinder the individual’s health goals,” she says.

For example, many in the African American community know there is a genetic component, but are less aware of how physical activity and nutrition can prevent or mitigate effects of the disease, Jordan says.

Food and family

Previous studies have shown family history—regardless of race, age, or income—is a strong predictor of obesity and type 2 diabetes. In the new paper, researchers explain that cultural acceptance of larger body size and optimistic bias may limit African Americans’ perceived risk for the disease. Some are also skeptical of the medical system, which can have negative consequences.

As with many cultures, food plays a central role in African American families. In the interviews, several parents and children talked about special foods prepared for holidays and family meals, Jordan says. Parents said they made the dishes for their children, but the children often did not realize the health consequences for their parents. For some families, the interviews were the first time parents and their adult children talked about these issues.

“I really saw the process unfolding of sharing information between the two generations, but also raising awareness about misconceptions, such as how we treated diabetes a generation ago is not the way we’re treating it now. Families must be diligent and open to getting updated and new information,” Jordan says.

Talk about it

Some parents openly talked about diabetes with their children and modeled healthy behaviors, but the study revealed a need for greater communication within families as well as with medical professionals.

Men were less likely to discuss their diagnosis—and some parents said they were reluctant to talk about it because they didn’t want to worry their children.

“Too often we heard about someone who had a major medical event, unfortunately, may have lost their life, simply because they were not sharing information with loved ones,” Jordan says.

There are a number of things families can do to improve communication and education about the disease, the researchers say:

• Open communication: To provide support, family members need to discuss the diagnosis and understand the course for management. Designate a point person who can attend doctor’s appointments and make sure the patient follows medication and management plans.
• Notify a coworker or manager: A medical emergency can happen at any time. Tell someone at work that you have type 2 diabetes and how they should respond if your blood sugar drops and you are unresponsive.
• Recognize potential barriers: Doctors and nurses need to make sure patients understand their diagnosis and feels comfortable asking questions. Awareness of cultural and family differences can help break down the barriers to successful management.

“I’d tell health care providers to do anything they can to help facilitate communication and build trust, recognizing they might not have done anything personally to violate that trust, but it’s systemic, it’s cultural,” Jordan says. “We’ve overcome a lot of things culturally and just recognize that it is probably in the room.”

Source: Iowa State University

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