The epidemic of type 2 diabetes in the U.S. is particularly acute in ethnic minority groups. Disproportionately high rates of diabetes, three times those observed in European Americans are found in Chinese Americans, the largest group of Asian Americans and one of the most rapidly growing immigrant groups. Health beliefs and practices based in Chinese tradition and medicine, and cultural norms compete or conflict with Western nursing and biomedical diabetes care approaches. Chinese Americans who have cultural concerns around family obligation and well-being are particularly challenged by health prescriptions that assume a Western individualistic orientation. The proposed study will examine the effects of cultural and family processes on self-management of type 2 diabetes among Chinese American patients.
Specific aims are to 1) examine health beliefs and practices regarding type 2 diabetes from the perspective of Chinese American patients with diabetes and their spouse/partner; 2) examine family processes of support and conflict management in regard to type 2 diabetes from the perspective of Chinese American patients with diabetes and their spouse/partner; 3) compare US- and foreign-born Chinese patients with type 2 diabetes and their spouse/partner to determine how beliefs, practices and family patterns change with acculturation. A descriptive comparative design is employed to compare U.S. and foreign-born Chinese immigrants and their families. Sixty Chinese American patients with type 2 diabetes (30 U.S.-born and 30 foreign-born) and their spouse/partners will be recruited from large health HMO's and community health clinics. Patients with partners who are 35-65, diagnosed at least one year, but with no major complications are sampled. Interpretive phenomenology is the method employed to articulate the cultural and family beliefs and practices that require adaptation in diabetes care provision. Multiple interpretive interviews will be conducted in-group, couple and individual contexts. Thematic and narrative analysis will be employed to analyze the interviews from patients and their spouses.
The aim i s to develop a practical theory of Chinese American patient and family beliefs and practices in diabetes care as the first step in a larger aim of developing culturally sensitive clinical health interventions for type 2 diabetes and its management with this population. This application addresses a National Institute of Nursing Research priority, to investigate cultural and ethnic considerations in health and illness.
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