title: Family and Community Influences on Diabetes-Related Dietary Change in a Low-Income Urban Neighborhood.
abstract: The purpose of this study is to explore the influence of the social environment, including family and community relationships, on diabetes-related dietary change behaviors in a low-income, predominantly African American community with limited access to healthy foods.
  
  
  
  Study methods included interviews and focus groups with adults with diabetes and family members of individuals with diabetes in a low-income African American community. In this analysis, interview participants included 11 participants with diabetes, one with prediabetes, and 8 family members or close friends with diabetes. Information from 4 participants with diabetes and 6 with family members with diabetes was included from 6 focus groups. Transcripts were analyzed via thematic iterative coding influenced by social cognitive theory to understand the influence of family and community relationships on dietary change.
  
  
  
  Participants' social environments strongly influenced diet-related behavioral change. Family members without diabetes provided reinforcements for dietary change for those with diabetes by preparing healthy food and monitoring intake, as well as by adopting dietary changes made by those with diabetes. Family and community members served as sources of observational learning about the potential impacts of diabetes and enhanced behavioral capability for dietary change among people with diabetes by providing dietary advice and strategies for making healthy choices.
  
  
  
  This study demonstrates the ways in which family and community members can influence dietary change in people with diabetes. Interventions targeting diabetes management should incorporate families and communities as sources of information, learning, and support.
authors.affiliation: Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard).
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Pollard
authors.affiliation: Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary).
authors.forename: Drew A
authors.initials: DA
authors.lastname: Zachary
authors.affiliation: Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan).
authors.forename: Katherine
authors.initials: K
authors.lastname: Wingert
authors.affiliation: Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker).
authors.forename: Sara S
authors.initials: SS
authors.lastname: Booker
authors.affiliation: Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan).
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D015142:Baltimore; D003920:Diabetes Mellitus / Q000178:diet therapy* / Q000523:psychology; D003927:Diet, Diabetic / Q000523:psychology*; D005190:Family / Q000523:psychology; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000523:psychology*; D036301:Qualitative Research; D012111:Residence Characteristics; D012931:Social Environment; D055815:Young Adult