Abstract
The purpose of this study was to examine belief systems about diabetes in American Indian elders, and the effects of culture on care-seeking, adherence, and diabetes self-care. Health belief theory predicts that care-seeking and medical adherence are a function of culturally mediated beliefs that result in behaviors that effect health status. In order to elicit cultural meanings of diabetes, in-depth interviews were conducted with an intensity sample of 30 American Indian diabetic elders (55+). Two models of diabetes were identified, divergent in terms of 1) health behaviors, and 2) cultural identification. One model was characterized by delayed care-seeking, and a non-valuing of adherence to diabetes self-care. Non-adherence to medical recommendations was perceived as being socially desirable, because adherence placed the elder outside their peer group. The second model was characterized by early care-seeking and improved adherence to diabetes self-care. These divergent models of diabetes, in which care-seeking, diabetes self-care, and adherence vary as a function of cultural immersion, has implications for health education and disease management and may contribute substantially to health disparities.
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Notes
The age group of 55 years and over was chosen to designate elder status, consistent with Indian Health Service guidelines (I.H.S. 1997). AI/AN elders experience more co-morbidities at younger ages than their counterparts in the white population.
The Certificate of Degree of Indian Blood (C.D.I.B.) card is issued to members of American Indian and Alaska Native tribes by the Bureau of Indian Affairs (B.I.A.). The issuance of the card is predicated on the enrollment of ancestors with the B.I.A., and designates the AI/AN from both federally recognized and non-federally recognized tribes. The C.D.I.B. card entitles tribal members to those trust benefits offered by the federal government which are specific to AI/AN persons, and which fulfill the trust responsibility of the federal government toward AI/AN tribal members.
The Community Health Representative (C.H.R.) Program is a unique community-based outreach program, staffed by a cadre of well-trained, medically-guided, tribal and Native community people, who provide a variety of health services within American Indian and Alaska Native communities. A Community Health Representative (C.H.R.) may include traditional Native concepts in his/her work and is funded with IHS-CHR appropriations.
The sample for this study was taken from a population of southeastern American Indian elders who live in Oklahoma, a state in which tribal boundaries are delineated but in which there is comparatively little reservation land legally held by the tribe. There is more intermarriage with non-indigenous people when compared to isolated reservation communities (Henderson and Henderson 2004).
The cultural identification assessment placed respondents in either an “indigenous” or “mainstream” category. These are terms of convenience for description and analysis. However, the technical limits of the use of these terms must be understood. At the individual level, the existence of absolute, dichotomous designations cannot experientially exist (Hill, Fortenberry and Stein 1990). For example, the “Acculturation Continuum” has positions along a line, at one end of which is the identifier “Traditional” and at the other “Assimilated.” The middle is designated “Bicultural,” and movement from one pole to the other reflects processes of “acculturation” (Valle 1989). People can be said to exist at any point on the continuum based on changing social and cultural environments, and movement can be due to situational social environment variance. It is not possible in today’s global cultural environment to be completely shielded from diverse cultural influences. The use of “indigenous” and “mainstream” to refer to the cultural identification of the elders is not perfect, but does not necessarily preclude an agreed upon “convenience usage.”
The terms “white man,” “white doctor,” “whites,” and so on, are those used by respondents in this study. The use of these terms by the respondents is demonstrative of the extent to which past abuses, discrimination, and disenfranchisement have instilled in American Indians a distrust, and often active dislike, for “white” people, and those that are symbols of the “white” authority. Abuses from the past have affected the health of the generations of American Indians.
According to the 2010 Clinical Practice Recommendations from the American Diabetes Association, a diagnosis of diabetes can be made when the fasting blood glucose level is equal to or over 126 mg/dl. A level of 400 would be considered an extremely urgent medical condition (American Diabetes Association 2007).
Allotment lands were those parcels of land deeded to AI persons when lands that previously belonged to tribal nations were opened to white settlers by the U.S. government. A typical parcel consisted of 160 acres.
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Henderson, L.C. Divergent Models of Diabetes among American Indian Elders. J Cross Cult Gerontol 25, 303–316 (2010). https://doi.org/10.1007/s10823-010-9128-4
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DOI: https://doi.org/10.1007/s10823-010-9128-4