Journal of General Internal Medicine

, Volume 28, Issue 3, pp 428–435 | Cite as

Family Diabetes Matters: A View from the Other Side

  • Carmen D. Samuel-Hodge
  • Crystal W. Cene
  • Leonor Corsino
  • Chelsea Thomas
  • Laura P. Svetkey
Original Research

ABSTRACT

BACKGROUND

Typically, chronic disease self-management happens in a family context, and for African American adults living with diabetes, family seems to matter in self-management processes. Many qualitative studies describe family diabetes interactions from the perspective of adults living with diabetes, but we have not heard from family members.

OBJECTIVE

To explore patient and family perspectives on family interactions around diabetes.

DESIGN

Qualitative study using focus group methodology.

PARTICIPANTS & APPROACH

We conducted eight audiotaped focus groups among African Americans (four with patients with diabetes and four with family members not diagnosed with diabetes), with a focus on topics of family communication, conflict, and support. The digital files were transcribed verbatim, coded, and analyzed using qualitative data analysis software. Directed content analysis and grounded theory approaches guided the interpretation of code summaries.

RESULTS

Focus groups included 67 participants (81 % female, mean age 64 years). Family members primarily included spouses, siblings, and adult children/grandchildren. For patients with diabetes, central issues included shifting family roles to accommodate diabetes and conflicts stemming from family advice-giving. Family members described discomfort with the perceived need to police or “stand over” the diabetic family member, not wanting to “throw diabetes in their [relative’s] face,” perceiving their communications as unhelpful, and confusion about their role in diabetes care. These concepts generated an emergent theme of “family diabetes silence.”

CONCLUSION

Diabetes silence, role adjustments, and conflict appear to be important aspects to address in family-centered diabetes self-management interventions. Contextual data gathered through formative research can inform such family-centered intervention development.

KEY WORDS

family interactions type 2 diabetes qualitative research African Americans 

Supplementary material

11606_2012_2230_MOESM1_ESM.doc (52 kb)
ESM 1(DOC 51 kb)

REFERENCES

  1. 1.
    Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/#Diagnosed20. Accessed 3 September 2012.
  2. 2.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the US population in 1988–1994 and 2005–2006. Diabetes Care. 2009;32:287–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Wadden TA, Butryn ML, Wilson C. Lifestyle modification for the management of obesity. Gastroenterology. 2007;132:2226–38.PubMedCrossRefGoogle Scholar
  5. 5.
    Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of typ 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.PubMedCrossRefGoogle Scholar
  6. 6.
    Wadden TA, West DS, Neiberg R, et al. One-year weight losses in the Look AHEAD Study: factors associated with success. Obesity. 2009;17:713–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Armour TA, Norris SL, Jack L Jr, et al. The effectiveness of family interventions in people with diabetes mellitus: a systematic review. Diabetes Med. 2004;22:1295–305.CrossRefGoogle Scholar
  8. 8.
    Chesla CA, Fisher L, Mullan JT, et al. Family and disease management in African-American patients with type 2 diabetes. Diabetes Care. 2004;27:2850–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Fisher L, Chesla CA, Bartz RJ, et al. The family and type 2 diabetes: a framework for intervention. Diabetes Educ. 1998;24:599–607.PubMedCrossRefGoogle Scholar
  10. 10.
    Bell RA, Summerson JH, Konen JC. Racial differences in psychosocial variables among adults with non-insulin-dependent diabetes mellitus. Behav Med. 1995;21:69–73.PubMedCrossRefGoogle Scholar
  11. 11.
    Samuel-Hodge CD, Gizlice Z, Cai J, Brantley PJ, Ard JD, Svetkey LP. Family functioning and weight loss in a sample of African Americans and whites. Ann Behav Med. 2010;40:294–301.PubMedCrossRefGoogle Scholar
  12. 12.
    Rosland AM, Piette JD. Emerging models for mobilizing family support for chronic disease management: a structured review. Chronic Illn. 2010;6:7–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Cole I, Chesla CA. Interventions for the family with diabetes. Nurs Clin N Am. 2006;41:625–39.CrossRefGoogle Scholar
  14. 14.
    Rosland AM, Heisler M, Choi HJ, Silveira MJ, Piette JD. Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help? Chronic Illn. 2010;6:22–33.PubMedCrossRefGoogle Scholar
  15. 15.
    Samuel-Hodge CD, Headen SW, Skelly AH, et al. 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. Diabetes Care. 2000;23:928–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Carter-Edwards L, Skelly AH, Cagle CS, et al. “They care but don’t understand”: family support of African American women with type 2 diabetes. Diabetes Educ. 2004;30:493–501.PubMedCrossRefGoogle Scholar
  17. 17.
    Jones RA, Utz SW, Williams IC, et al. Family interactions among African Americans diagnosed with type 2 diabetes. Diabetes Educ. 2008;34:318–26.PubMedCrossRefGoogle Scholar
  18. 18.
    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.PubMedCrossRefGoogle Scholar
  19. 19.
    Guidelines for Critical Review Form: Qualitative Studies (Version 2.0) by Letts L, Wilkins S, Law M, Stewart D, Bosch J, & Westmorland M, 2007. Available at: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualguidelines_version2.0.pdf. Accessed 3 September 2012.
  20. 20.
    Hartmann M, Bazner E, Wild B, Eisler I, Herzog W. Effects of interventions involving the family in the treatment of adult patients with chronic diseases: a meta-analysis. Psychother Psychosom. 2010;79:136–48.PubMedCrossRefGoogle Scholar
  21. 21.
    Martire LM, Lustig AP, Schulz R, Miller GE, Helgeson VS. It is beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness. Health Psychol. 2004;23:599–611.PubMedCrossRefGoogle Scholar
  22. 22.
    Samuel-Hodge CD, Skelly AH, Headen S, Carter-Edwards L. Familial roles of older African-American women with type 2 diabetes: testing of a new multiple caregiving measure. Ethn Dis. 2005;15:436–43.PubMedGoogle Scholar
  23. 23.
    Fisher L, Chesla CA, Skaff MM, Mullan JT, Kanter RA. Depression and anxiety among partners of European-American and Latino patients with type 2 diabetes. Diabetes Care. 2002;25:1564–70.PubMedCrossRefGoogle Scholar
  24. 24.
    Fisher L, Chesla CA, Skaff MM, et al. The family and disease management in Hispanic and European-American patients with type 2 diabetes. Diabetes Care. 2000;23:267–72.PubMedCrossRefGoogle Scholar
  25. 25.
    Rosland AM, Kieffer E, Isreal B, et al. When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. J Gen Intern Med. 2008;23:1992–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol. 2004;23:58–66.PubMedCrossRefGoogle Scholar
  27. 27.
    Williams GC, Patrick H, Niemiec CP, et al. Reducing the health risks of diabetes: how self-determination theory may help improve medication adherence and quality of life. Diabetes Educ. 2009;35:484–92.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Carmen D. Samuel-Hodge
    • 1
  • Crystal W. Cene
    • 2
  • Leonor Corsino
    • 3
  • Chelsea Thomas
    • 4
  • Laura P. Svetkey
    • 5
  1. 1.Department of Nutrition, Gillings School of Global Public Health, School of Medicine, and Center for Health Promotion and Disease PreventionUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Medicine, School of MedicineUniversity of North CarolinaChapel HillUSA
  3. 3.Division of Endocrinology and Metabolism, Department of MedicineDuke University Medical CenterDurhamUSA
  4. 4.Center for Health Promotion and Disease PreventionUniversity of North CarolinaChapel HillUSA
  5. 5.Sarah W. Stedman Nutrition and Metabolism Center, Division of Nephrology, Department of MedicineDuke University Medical CenterDurhamUSA

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