title: Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors.
abstract: OBJECTIVE
  Many African-American women are affected by diabetes and its complications, and culturally appropriate lifestyle interventions that lead to improvements in glycemic control are urgently needed. The aim of this qualitative study was to identify culturally relevant psychosocial issues and social context variables influencing lifestyle behaviors--specifically diet and physical activity--of southern African-American women with diabetes.
  
  
  METHODS
  We conducted 10 focus group interviews with 70 southern African-American women with type 2 diabetes. Group interviews were audiotaped and transcripts were coded using qualitative data analysis software. A panel of reviewers analyzed the coded responses for emerging themes and trends.
  
  
  RESULTS
  The dominant and most consistent themes that emerged from these focus groups were 1) spirituality as an important factor in general health, disease adjustment, and coping; 2) general life stress and multi-caregiving responsibilities interfering with daily disease management; and 3) the impact of diabetes manifested in feelings of dietary deprivation, physical and emotional "tiredness," "worry," and fear of diabetes complications.
  
  
  CONCLUSIONS
  Our findings suggest that influences on diabetes self-management behaviors of African-American women may be best understood from a sociocultural and family context. Interventions to improve self-management for this population should recognize the influences of spirituality, general life stress, multi-caregiving responsibilities, and the psychological impact of diabetes. These findings suggest that family-centered and church-based approaches to diabetes care interventions are appropriate.
authors.affiliation: Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, USA. carmen.samuel@sph.unc.edu
authors.forename: C D
authors.initials: CD
authors.lastname: Samuel-Hodge
authors.forename: S W
authors.initials: SW
authors.lastname: Headen
authors.forename: A H
authors.initials: AH
authors.lastname: Skelly
authors.forename: A F
authors.initials: AF
authors.lastname: Ingram
authors.forename: T C
authors.initials: TC
authors.lastname: Keyserling
authors.forename: E J
authors.initials: EJ
authors.lastname: Jackson
authors.forename: A S
authors.initials: AS
authors.lastname: Ammerman
authors.forename: T A
authors.initials: TA
authors.lastname: Elasy
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D017028:Caregivers; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000534:rehabilitation*; D003927:Diet, Diabetic; D004644:Emotions; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D012069:Religion and Psychology; D012648:Self Care; D012917:Social Adjustment; D012944:Social Support; D013315:Stress, Psychological; D014481:United States; D014930:Women