The goal of this longitudinal research is to elicit cultural models of parental/caregiver distress (P/CD) as it evolves over two years of time among families coping with dependents diagnosed with Type 1 diabetes (T1D), and for comparison. Type 2 diabetes (T2D), in infants and children through age 18. Cultural models of distress will be analytically ascertained from parent/caregiver experimentally-based perspectives gained by providing care to these young diabetics. The subject populations will be 20 Oklahoma Choctaw families coping with diabetes in children (ages infant-18 years): 10 families with T1D and 10 families with T2D participating in the Choctaw Nation Pediatric Diabetes Clinic. Five data collection strategies are used: 1) Face page for demographic and other social data, 2) the Henderson Degree of Cultural Identification Questionnaire to ascertain acculturation status, 3) Free Listing to ascertain subject-derived categories of P/CD, 4) unstructured interviews eliciting direct discourse on P/CD, and 5) semi-structured interviews based on data from the unstructured interviews, plus theoretically derived categories of P/CD. Data analysis uses a mixed inductive-deductive strategy with a defined set of categories of interest relevant to P/CD and derived both from subjects and theory. Inter-rater reliability calculations are routinely done along with daily meetings with coders. The categories of distress will be examined for influence by contemporary, heterogeneous Choctaw cultural factors, including acculturation status, use of tribal health services, diffusion of caregiving across the kinship group, and religious/spiritual participation in native as well as majority culture alternative healing techniques. The findings will be used to promote improved caregiver coping, health of the dependent, and provision of new family-derived and practice-relevant facts of diabetes in context for providers to Oklahoma Choctaw people. The dissemination and translation of the findings will be done by in service training workshops for the Behavioral Medicine Department of the Choctaw Nation Hospital and professional scientific presentations and publications.
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