The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58502

L. Carson Henderson, PhD, MPH, Two Hawk Institute, P.O. Box 2258, Oklahoma City, OK 73101-2258, (405) 740-2869, twohawkinstitute@cox.net

Diabetes constitutes a major health disparity between American Indian and Mainstream populations. Because management of disease is affected by divergence of values and beliefs between patients and providers, understanding the cultural construction of disease of both groups may be critical to reducing non-compliance and disease burden in American Indian diabetics. In a field setting using ethnographic techniques, in-depth interviews were conducted with an intensity sample of 30 American Indian diabetic elders (55+)in order to elicit cultural meanings of diabetes. When compliance and care-seeking behaviors were examined, the majority of non-compliers were culturally traditional. Non-compliance was perceived as being socially acceptable and it was desirable to demonstrate defiance towards medical authority. Among compliers, the majority were acculturated. Traditionalism was also associated with delayed care seeking behavior. Additionally, in-depth interviews were conducted with an intensity sample of 30 health care providers to elicit biomedical meanings of diabetes relative to American Indian culture. While providers distinguished between traditional and acculturated elders when a thematic apperception tool was administered, responses to specific questions about care-seeking and compliance between the two groups indicated that traditional or acculturated status was considered irrelevant. Divergence was found between providers’ perspectives of reasons for late care-seeking and non-compliance and elderly diabetics’ cultural construction of the disease. This divergence may contribute to the variance in diabetes outcomes between the American Indian and mainstream populations.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
• Identify four cultural models of diabetes
• Discuss the investigative process used for elicitation of cultural constructions of disease
• List public health interventions which may decrease the possibiltity of cross-cultural miscommunication regarding health and illness

Keywords: Diabetes, Cultural Competency

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.