Sociocultural Influences on African Americans' Representations of Type 2 Diabetes: A Qualitative Study.

Objective: Illness representations, known as patients' beliefs and expectations about an illness, may be influenced by cultural beliefs and personal experiences. This study explored African Americans' perceptions of the sociocultural factors that influence their representations of diabetes. Design: Six semi-structured focus groups. Setting: Private space at a convenient site. Participants: Forty African Americans, aged 45-60 years with type 2 diabetes for at least one year prior.
Results: Participants perceived that there was a race-mediated effect of how they developed diabetes because of poverty due to past slavery, racial discrimination by health care providers, and the stigma associated with diabetes within the African American community. Participants perceived that poverty influenced African Americans' unhealthy eating habits, which led to diabetes diagnosis among their ancestors and their development of the disease since it was hereditary. Participants also perceived that there was provider ill intention, ie, providers were purposefully making people sick, and their lack of education on diabetes from providers was done on purpose, as information on diabetes was withheld and not shared due to racial discrimination. Perceived stigma by the community led to African Americans' avoidance and denial of the disease, and subsequently the development of diabetes. Conclusions: To enhance disease management for African Americans with diabetes, it is important to focus on the sociocultural context of how African Americans view their world that may be influenced by their knowledge of negative historical circumstances and their current provider relationship, which, in turn, may be reflected in their perceptions of diabetes.