Lessons from Stories of Diabetes Self-Management: Enunciating Culture in Health Decision-Making in the Third Space

Increasing rates of type 2 diabetes in Indigenous populations are a complex and critical problem. The requirements of diabetes self-management are challenging and few interventions have produced meaningful improvements for Indigenous people with diabetes. Studies have reported that when Indigenous people seek help with diabetes from the medical system they face racial discrimination and barriers rooted in cultural difference and misunderstanding. In this dissertation, I explore the intersections of culture and health care in the context of Indigenous peoples’ experience with diabetes self-management. This study combines critical ethnographic methods with the theory of postcolonial scholar Homi Bhabha to provide new insights into how members of a colonized group (the subaltern) experience the world from a figurative third space between the culture of the colonizer and the culture of the colonized. In the third space, experiences are translated uniquely, since the subaltern has knowledge of both the culture of the colonizer and their own culture. Based on this process of translation, a person in the third space enunciates their cultural difference through words and actions that challenge, unsettle, or infiltrate the colonial power. I conducted storytelling sessions with ten Indigenous community members in Fort Smith, Northwest Territories in Canada to explore how Bhabha’s third space theory can applied to the experiences of Indigenous people navigating the third space between the mainstream Canadian medical culture and Indigenous culture and enunciating cultural difference through diabetes self-management behaviours. This work disrupts the traditional understanding of individual level behaviour change by addressing the mechanism through which individual health decision-making is influenced by experience translated through the lens of colonization. I argue that, while the Western medical system is part of a colonial structure, the third space model provides an opportunity to understand how Indigenous people develop self-management behaviours that are culturally informed and discursively strategic.Ph.D