Developing a Pilot Stress Reduction Intervention for African Americans with Type 2 Diabetes

Purpose: Black Americans are disproportionately affected by type 2 diabetes (T2DM) and incur more frequent complications and worse clinical outcomes. Chronic, low-grade tissue inflammation related to obesity contributes to insulin resistance, the major cause of T2DM and increases its macro- and microvascular complications. Physiologic and potentially psychological stressors may exacerbate inflammation as well as inhibit self-management behaviors. The current study seeks to identify psychological stressors and coping mechanisms among African Americans (AA) with T2DM in order to inform stress reduction intervention strategies.

Methods: Twenty-five AA participants with diabetes were administered semi-structured interviews regarding stressors, the effect of stressors and coping strategies on their T2DM management. Interviews lasted 30 minutes on average and were audio-recorded and transcribed verbatim. Content analysis was employed to develop themes from the transcribed interviews.

Results: Participants were black women (n=20) and men (n=5) ages 41 to 65. Several themes emerged related to the role stress plays in T2DM management. Participants reported stressors such as care-giving for family members, financial limitations, and work-related duties that they perceived to have direct negative effects on blood glucose levels and, further, inhibited their self-management behaviors. Common coping mechanisms reported include listening to [inspirational] music, prayer, resting, walking, talking to friends/family and volunteering to “forget their own problems”. Participants endorsed group-based, not individual, stress reduction activities with peers, reporting that communication further relieved stress.

Implications: Interview results will be used to develop a pilot, culturally-competent, and multi-component, group-based, stress reduction intervention, to promote adequate coping and improve diabetes self-management behaviors.