Living with diabetes on Buffalo, New York's culturally diverse West Side.
OBJECTIVE
This study explores the perceptions, attitudes, and beliefs that inform how people live with diabetes in a high poverty, ethnically diverse neighborhood with a growing population of refugees. The specific research objective was to examine participants' explanations of how their diabetes began, understandings about the illness, description of symptoms, as well as physical and emotional reactions to the diagnosis.


METHODS
Qualitative design using semi-structured interviews. The transcripts were analyzed using an immersion-crystallization approach.


RESULTS
Thirty four individuals diagnosed with diabetes for at least 1 year participated. The sample included 14 refugees (from Somalia, Sudan, Burma, or Cuba), eight Puerto Ricans, six non-Hispanic Caucasians, six African-Americans, and two Native Americans. Three broad themes were identified across ethnic groups: (a) the diagnosis of diabetes was unexpected; (b) emotional responses to diabetes were similar to Kubler-Ross's stages of grief; (c) patients' understanding of diabetes focused on symptoms and diet.


CONCLUSIONS
Patients were frequently stunned by the diagnosis of diabetes, and expressed emotions associated with the stages of grief including denial, anger, bargaining, depression, and acceptance. Our findings suggest that clinicians might consider addressing the patients' emotions or grief reaction as an early priority to promote acceptance as a first step to self-management.
Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY 14203, USA. lskahn@buffalo.edu
Linda S
LS
Kahn
Bonnie M
BM
Vest
Renée
R
Karl
Laurene
L
Tumiel-Berhalter
Robert
R
Taylor
Roseanne C
RC
Schuster
Kathryn
K
Glaser
Alexandra
A
Danakas
Chester H
CH
Fox
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000786:Anger; D001294:Attitude to Health / Q000208:ethnology; D018864:Cultural Diversity; D003717:Denial, Psychological; D003863:Depression; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009518:New York; D010865:Pilot Projects; D011204:Poverty Areas; D036301:Qualitative Research; D044469:Racial Groups / Q000523:psychology; D012036:Refugees / Q000523:psychology; D055815:Young Adult