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Title: Gender Differences in Facilitators and Barriers to Type-2 Diabetes Adherence in African Americans [2009]

Authors: Sula Hood, M.P.H.,1 Diane Chlebowy, Ph.D., R.N.,2 A. Scott LaJoie, Ph.D., M.S.P.H.1 Health Promotion and Behavioral Sciences1 and Nursing Education.2

Keywords: Diabetes, African American


Purpose: The purpose of this study was to assess gender differences in facilitators and barriers to adherence to management guidelines for type-2 diabetes in African Americans.

Background: African Americans are disproportionately impacted by type-2 diabetes, having the highest diabetes-related incidence, morbidity, and mortality rates of all racial and ethnic groups.  Current literature suggests that African Americans are significantly less adherent to self-management recommendations than whites, possibly accounting for increased complications and mortality rates among this population (Shenolikar, Balkrishnan, Camacho, Whitmire, & Anderson, 2006, p. 1075). To date, studies to understand factors influencing adherence in this population primarily have been quantitative.  Furthermore, qualitative studies have been limited to females.  It is imperative to also include African American males in qualitative studies, as gender may play a crucial role in understanding adherence behaviors. 

Methods: African Americans with type-2 diabetes were interviewed in focus groups.  Four groups consisted of female participants, and three groups consisted of male participants, for a total of 38 participants.  The sessions were recorded, transcribed, coded, and analyzed.  Analyses were conducted using Atlas ti qualitative data analysis software.  The Health Belief Model was the theoretical framework used to guide the analysis.

Findings:  Female participants emphasized pain as a barrier to adherence to regular glucose monitoring.  Female participants also indicated a greater perceived severity of diabetes complications, and often referenced mortality more than male participants.  Perceived sense of self-efficacy for diabetes adherence and self-management varied by gender.  Male participants often expressed a high degree of perceived control in managing their diabetes, and were optimistic.  In contrast, female participants felt less control over their ability to manage their diabetes, and often noted stress and frustration.  Male participants emphasized the necessity of a structured schedule for timely medication administration.  Specifically, memory was noted as a barrier to timely medication administration for males.  In contrast, female participants indicated that memory was a barrier to timely glucose monitoring and eating.  Social support from peers, family members and other social networks were noted facilitators to diabetes adherence by both gender groups.  Female participants expressed the importance of and need for peer networks to exchange information on how to manage their diabetes.  Male participants focused less on peer networks, and acknowledged familial support for their diabetes management, including assistance with organizing medication.

Conclusion:  Male and female participants perceive similar barriers and facilitators to diabetes adherence.  Appraisal of these barriers and facilitators differ by gender.

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