American Indian talking circles and diabetes self-management-a qualitative study

The culturally appropriate Talking Circle (TC) was used as one intervention to improve diabetes self-management behaviors for American Indian study participants with HbA1c's of 7 or greater. Each of the two groups of study participants met once a week for 12 weeks. The TC was facilitated by a tribal elder with well controlled DM2 and experience as a TC leader. Cultural themes significant to the TC participants were spirituality which included prayers, relationship to God (Wakonda) and blessings for those who were objects of the prayers. Additional themes or characteristics of the culture that were evident throughout the TC sessions were gratitude, sharing, and humor. The major topics of the discussions were the experiences of living with DM2. The subcategories of themes expressed included the challenges of having DM2. These challenges were: fatalism, denial, difficulties related to medication adherence and regimen compliance, achieving acceptance and the effects of DM2 on families. Another category was coping with DM2. Coping included reasons for participating in the TC, motivators for adherence to medication and dietary regimens, specific behaviors that promoted adherence, and the effects of adherence. Study participants consistently identified that what they liked best about the TC was the sharing, hearing others' stories, and knowing they were not alone. Suggestions for what health care providers should know are given.