American Indians' Family Health Concern on a Northern Plains Reservation: "Diabetes Runs Rampant Here".
OBJECTIVE
The objective was to identify significant family health concerns from the perspective of adult tribal members residing in a reservation setting on the Northern Plains of the United States. Findings were used to cocreate culturally appropriate strategies to address the most significant family health concern.


METHODS
A focused ethnography within a participatory framework was employed. An advisory council, comprised of seven tribal members, guided the research team. A purposive sampling technique with a snowball process was used. Twenty-one adult tribal members volunteered to participate.


METHODS
Face-to-face, audio-recorded, semi-structured interviews were conducted and transcribed verbatim. Other data sources included field notes of approximately 100 hours of field work, windshield surveys, and a focus group. Data were analyzed using Spradley's guidelines.


RESULTS
The significant family health concern was "diabetes runs rampant here" with inter-related cognitive, emotional, and behavioral responses. These responses were compounded by accumulated emotional trauma from witnessing premature deaths and severe comorbidities associated with diabetes. Contextual factors shaping "diabetes runs rampant here" were identified.


CONCLUSIONS
Holistic approaches are urgently needed in diabetes prevention and management programs. Implications for public health nurses are discussed and recommendations are provided for future research.
College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
Donna
D
Martin
College of Nursing & Professional Disciplines, University of North Dakota, Grand Forks, North Dakota.
Eleanor
E
Yurkovich
College of Nursing & Professional Disciplines, University of North Dakota, Grand Forks, North Dakota.
Kara
K
Anderson
D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology / Q000523:psychology; D005192:Family Health / Q000208:ethnology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
Indians; North American; culture; diabetes mellitus; ethnography; family health; family nursing; public health