Interpretive phenomenologic study of diabetes beliefs and practices among first generation Asian Indians in the US

Purpose: In the United States one in six Asian Indians (AI) is diagnosed with type 2 diabetes and the prevalence of diabetes in AI (between ages 45-79) in the San Francisco Bay Area is 29%. Although culturally distinct issues have been anticipated, only a few studies have examined AI beliefs and practices regarding diabetes. The purpose of this study was to explore and understand cultural commonalities and differences in illness management in AIs. Aims of this study were to describe: 1) Beliefs about causal factors and diabetes management 2) Daily challenges and supports encountered in managing type 2 diabetes; 3) Culturally specific practices (religious, dietary and physical activity) that affected type 2 diabetes; 4) Commonalities and differences by gender differences that impacted type 2 diabetes. The overall goal was to provide an interpretive account of the daily activities, challenges and barriers faced by AI in managing their diabetes in their everyday lives. Approach: Interpretive phenomenology (IP) guided the research design and analysis. In-depth narrative and explanatory data about health beliefs and practices was gathered through open–ended interviews. A convenience sample of 12 adult participants (50% female) between the ages of 40-79 who self-identified as first generation AI, diagnosed with type 2 diabetes, low income with average duration of U.S. residency of 20 years were recruited via public announcements and in person presentations at Sikh Temples. Each participant was interviewed twice in English or Punjabi to learn illness understandings including cause, culturally specific practices, supports and barriers to illness management. Results: The high prevalence of diabetes in the AI community led participants to express a sense of inevitability for developing the disease. Participants uniformly suggested that social and environmental causes outweighed hereditary or biological causes for their diabetes although beliefs were gender-specific. Female participants named stressors that disrupted family harmony and overwhelming family responsibility, and a lack of quality communication with their physicians as contributing to their diabetes. Male participants suggested that employment stresses and poor diet were causal. Diabetes management was complicated by dietary, cultural and social practices. Lack of knowledge, poor access to medical care and immigration further hindered diabetes control.Conclusion: Efforts in prevention and community outreach programs are needed as the AI population increases in the United States. Public health initiatives that increase early screening and awareness of diabetes may improve diabetes and its complications in the AI community. Culturally specific diabetes prevention programs for AI, assistance in managing social and environmental contributors to diabetes must be addressed alongside lifestyle (diet and exercise) changes