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APHA Scientific Session and Event Listing

Emily A. Elstad, MPH¹, Corabelle Tusiofo, CDE², Rochelle K. Rosen, PhD³, John Tuitele, MD², and Stephen T. McGarvey, PhD, MPH⁴. (1) MPH program, Brown University, 11 Orrin St. #3, Cambridge, MA 02138, (401) 787-7254, Emily_Elstad@Brown.edu, (2) Tafuna Family Health Center, P.O. Box 3965, Pago Pago, 96799, American Samoa, (3) Centers for Behavioral and Preventive Medicine, The Miriam Hospital, One Hoppin Street, Suite 500, Providence, RI 02903, (4) International Health Institute, Brown University, Box G-S2, Providence, RI 02912

Objectives: Chronic diseases are an increasing problem in the developing world, and in the U.S. territory of American Samoa, a disproportionate number of people suffer from diabetes compared with neighboring Samoa and the U.S. The design of culturally appropriate interventions to help prevent and manage diabetes requires formative qualitative research on what it means to be diabetic in Samoan culture.

Methods: Focus groups were held in 2005 at a primary health care facility to explore perceptions of diabetes, including its meaning, etiology, and the illness experience. Seven focus groups with a total of 64 participants were conducted in the Samoan language. Participants were diabetics at the health center and their family caregivers. Following translation, systematic analysis of the transcripts was performed using QSR NVivo 2 software.

Results: Diabetes was defined through its symptoms, characterized as “sugar disease,” and deemed a new, non-Samoan illness. Major causal themes included food, lack of exercise, and family history. The Samoan experience of living with diabetes differed by gender. Men struggled with being “diabetic,” expressing feelings of frustration, denial, and body betrayal. Women commonly referenced their doctor's advice and spoke positively about management successes.

Conclusions: Samoans linked diabetes to lifestyle, including recent changes away from traditional diet and exercise and the introduction of non-traditional “fast” foods. Consequently, interventions should emphasize appropriate diet and exercise. Male and female diabetics may be in different stages of change, and men may need more support negotiating the notion of diabetic self in order to facilitate successful management.

Learning Objectives: