title: Emotional and Behavioral Aspects of Diabetes in American Indians/Alaska Natives.
abstract: American Indians and Alaska Natives (AI/ANs) bear a disproportionate burden of diabetes and associated long-term complications. Behavioral interventions play a vital role in promoting diabetes medical and psychological outcomes, yet the development of interventions for AI/AN communities has been limited. A systematic review was conducted of studies focused on the psychosocial and behavioral aspects of diagnosed diabetes among AI/ANs. Ovid and PubMed databases and published reference lists were searched for articles published between 1987 and 2014 that related to the psychosocial and behavioral aspects of type 1 or type 2 diabetes in the AI/AN population. Twenty studies were identified that met the inclusion criteria. Nineteen studies were observational and one study was intervention based. Two of the studies used community-based participatory research methodology. Of the 20 studies, 2 discussed cultural influences associated with diabetes self-management and 10 identified the specific tribes that participated in the study. Tribal affiliations among the studies were broad with the number of AI/AN participants in each study ranging from 30 to 23,529 participants. Emotional and behavioral topics found in the literature were adherence ( n = 2), depression ( n = 9), physical activity ( n = 3), psychosocial barriers ( n = 1), social support ( n = 3), and stress ( n = 2). Relatively few studies were identified using AI/AN populations over a 27-year period. This is in stark contrast to what is known about the prevalence and burden that type 1 and type 2 diabetes mellitus place on AI/AN communities. Future research should promote community engagement through the use of community-based participatory research methodologies, seek to further understand and describe the emotional and behavioral context for diabetes self-management in this population, and develop and test innovative interventions to promote the best possible diabetes outcomes.
authors.affiliation: 1 Indiana University School of Nursing, Indianapolis, IN, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Scarton
authors.affiliation: 2 Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: de Groot
mesh_terms: D000072957:Alaska Natives / Q000523:psychology*; D002908:Chronic Disease; D003469:Culture; D003863:Depression; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000523:psychology*; D019468:Disease Management; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012944:Social Support
keywords: chronic disease management; community health; diabetes; health disparities; race/ethnicity