Background: Type 2 diabetes (T2DM) has been and continues to be a devastating disease for African- American women (AAW). In 2006 AAW had the largest increase in diagnosed diabetes in the United States, climbing from 7.9% in 2004 to 9%. One of the foundational diabetes self-care skills is proper food habits, but traditional expectations of family members may make it more difficult for AAW to improve their eating habits to achieve diabetes control. Few studies have focused solely on dietary changes, particularly in the context of the family and the role of AAW, to improve diabetes control. Objectives: The purpose of this in-depth ethnographic study is to better understand cultural food practices and how these practices are impacted by dietary related recommendations for AAW with T2DM. The proposed study builds upon the PI's pilot work and clinical experiences, which suggest that certain culturally-based food practices may be resistant to change but healthy modifications that take culture into consideration may be more acceptable. Further in-depth study is needed to detect common cultural influences on food practices in this population.
The specific aims are to: 1) describe typical daily food practices of AAW with T2DM;and 2) identify the cultural influences on food practices of AAW with T2DM. The long-term objective of the proposed study is to address NINR priorities by designing culturally tailored self-management decision-making strategies that promote healthy dietary lifestyle choices in AAW. Design &Method: Symbolic Interactionism, a sensitizing framework for viewing AAW with T2DM as a subculture, will guide this ethnographic study. A purposive sampling plan will identify 15 to 20 AAW between the ages of 35 and 70 years and diagnosed with T2DM, who shop for food and prepare meals for their families. Potential participants will be recruited through community churches and social contacts. Data collection will consist of moderate participant observation of: 1) one to two church fellowship dinners to observe eating in social situations;2) shopping for food in the grocery store;3) preparing food in the home;4) dining with the participant (only upon request);and 5) one-on-one interviews. A social anthropological approach to content analysis will be used to describe behavioral regularities in food selection and preparation in everyday real-life situations. The field notes and transcribed audio recordings will be searched in several stages for common phrases, patterns or themes and sequences. Conclusion: AAW are suffering in epidemic proportions from the effects of T2DM. Because AAW are the gatekeepers for food practices and the overall health of the family, they are the keys to cultural dietary modifications to improve diabetes control. This study will begin to fill the gap in the literature regarding cultral dietary food habits. With increased understanding of these practices, health care providers will be better able to improve diabetes control and decrease morbidity, mortality, and costs for AAW with T2DM.

Public Health Relevance

African Americans are twice as likely to develop T2DM, and hospitalizations due to diabetes complications are 1.5 times higher than Caucasian Americans. This study will begin to fill the gap in the literature regarding cultural dietary food habits, thu increasing understanding of these practices. With increased understanding, health care providers will be better able to improve AAW food habits, improve diabetes control, and decrease morbidity, mortality, and costs for AAW with T2DM.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Texas Austin
Schools of Nursing
United States
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Sumlin, Lisa L; Brown, Sharon A (2017) Culture and Food Practices of African American Women With Type 2 Diabetes. Diabetes Educ 43:565-575