Academic journal article American Journal of Health Education

Diabetes Self-Management Education for African Americans: Using the PEN-3 Model to Assess Needs

Academic journal article American Journal of Health Education

Diabetes Self-Management Education for African Americans: Using the PEN-3 Model to Assess Needs

Article excerpt

Background: African Americans are 2.2 times more likely to die from diabetes than whites. Culturally sensitive diabetes self-management education (DSME) is an approach to respond to this problem. Purpose: The purpose of this qualitative study is to assess African Americans' experiences managing type 2 diabetes. Results from this study will guide the development of a DSME intervention. Methods: Two focus groups with African Americans over the age of 18 (N = 17) were conducted. Sessions were audio-recorded and transcribed. Data were analyzed using content analysis and comparative method. The thematic findings were applied to the PEN-3 Cultural Framework. Findings: In the relationships and expectations domain, perceptions affecting disease management were feeling highly confident, fears about diabetes complications, and denial. Positive enablers were religion and social support. Negative enablers were disliking needles, time consumption, and cost of healthy foods. Nurturers consisted of family, friends, and health care providers. Cultural empowerment attributes were positive (spirituality and family), existential (faith healing), and negative (unhealthy traditional foods). For cultural identity, diabetes education was a need, especially family-focused intervention. Translation to Health Education Practice: Qualitative research, such as focus groups, provides health educators with a useful tool to conduct needs assessments to plan culture-centered health programs.


The high incidence of diabetes among African American adults is a serious, complex problem that warrants attention. Type 2 diabetes occurs in 90% to 95% of all diagnosed cases. (1) Older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity are factors associated with the development of type 2 diabetes. (1) Type 1 or juvenile-onset is common among children and makes up 5 % of the adult cases. (1)

Diabetes prevalence rates are nearly double for African Americans (18.7%) compared to whites (10.2%). (1) Similarly, African Americans' diabetes mortality per 100 000 is more than twice that of their white counterparts, 41.3 versus 19.1, respectively. (2) In 2007, there were more African American patients alive with end-stage renal complications than whites. (3) Recent estimates indicate that there are 5,545,700 African American adults with diabetes (diagnosed and undiagnosed). (4) These numbers are projected to increase to 9,517,200 by 2025, a 72% increase. (4) Equally alarming is the resulting cost totaling $49.8 billion, which includes medical and lost productivity expenses. (4)

Diabetes disparities for some segments of African Americans have been the result of socioeconomic barriers, such as lower levels of education, poverty, and lack of insurance. (5,6) Rural African Americans reported encountering many personal obstacles, such as the high cost of medicines and supplies, managing other chronic conditions, the daily experience of living with diabetes, stress, and sleeping problems associated with blood glucose fluctuations. (7,8) These problems underscore the myriad of complex challenges associated with self-care that can potentially lead to poor outcomes. Further, the dearth of culturally sensitive health care services is a salient issue for African Americans.

Translating evidence-based approaches in diabetes self-management education (DSME) for African Americans is a strategy to narrow the gap in diabetes disparities. Moreover, research suggests that these programs are effective in improving the health status of African Americans with diabetes. (9-15) Culturally competent DSME is recommended for minority populations, especially those that are empowerment based. (16) According to Brown and colleagues, there are 2 key components of a culturally competent DSME intervention (17) First, the program matches to the superficial characteristics of the target population, such as using the same language and incorporating cultural music and food. …

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