Family experiences of African Americans influence risk and management of Type 2 diabetes

Reviewed by James Ives, M.Psych. (Editor)Jul 25 2019

African American families not only share a higher risk for Type 2 diabetes, but many myths and misconceptions about the disease are often passed on from one generation to the next.

To understand how family experiences influence risk and management of the disease, a team of Iowa State University researchers interviewed parents and adult children of 20 African American families with strong histories of Type 2 diabetes. The interviews focused on diagnosis, physical activity and nutrition, resources for managing the disease, family support and communication, and allowed researchers to dig deeper into family dynamics.

"We wanted to get into the meanings and nuances within the family culture to identify some malleable targets we can work with," said Tera Jordan, an ISU associate professor of human development and family studies who conducted the interviews. "By understanding the meanings people have around food and nutrition, we might find ways they can make change."

The study, published in the journal Global Qualitative Nursing Research, identified two primary themes - family interactions and intergenerational openness - that shaped what younger generations knew and did about the disease. Brianna Routh, lead author and assistant professor at Montana State University, was part of the research team while a graduate student at Iowa State. She says the results provide insight that may help doctors and nurses counsel African American patients.

Some family interactions could directly inform an individual's behaviors and ability to manage their diabetes, so it is important for medical professionals to ask questions to better understand how these interactions might support or hinder the individual's health goals."

Brianna Routh, lead author, assistant professor, Montana State University

For example, many in the African American community know there is a genetic component, but are less aware of how physical activity and nutrition can prevent or mitigate effects of the disease, Jordan said.

Significance of food and family

Previous studies have shown family history - regardless of race, age or income - is a strong predictor of obesity and type 2 diabetes. In their paper, ISU researchers explained that cultural acceptance of larger body size and optimistic bias may limit African Americans' perceived risk for the disease. Some are also skeptical of the medical system, which can have negative consequences.

As with many cultures, food plays a central role in African American families. In the interviews, Jordan says several parents and children talked about special foods prepared for holidays and family meals. Parents explained that they made the dishes for their children, but the children often did not realize the health consequences for their parents. For some families, the interviews were the first time they had talked about these issues.

"I really saw the process unfolding of sharing information between the two generations, but also raising awareness about misconceptions, such as how we treated diabetes a generation ago is not the way we're treating it now. Families must be diligent and open to getting updated and new information," Jordan said.

Lessons for families, medical professionals

Some parents openly talked about diabetes with their children and modeled healthy behaviors, but the study revealed a need for greater communication within families as well as with medical professionals. The researchers noted gender differences - men were less likely to discuss their diagnosis - as well as concerns from parents reluctant to talk about it because they did not want to worry their children.

"Too often we heard about someone who had a major medical event, unfortunately, may have lost their life, simply because they were not sharing information with loved ones," Jordan said.

The researchers offer the following recommendations to improve communication and education about Type 2 diabetes:

• Open communication: To provide support, family members need to discuss the diagnosis and understand the course for management. Designate a point person who can attend doctor's appointments and make sure medication and management plans are followed.
• Notify a coworker or manager: A medical emergency can happen at any time. Tell someone at work that you have Type 2 diabetes and how they should respond if your blood sugar drops and you are unresponsive.
• Recognize potential barriers: Doctors and nurses need to make sure patients understand their diagnosis and feels comfortable asking questions. Awareness of cultural and family differences can help break down the barriers to successful management.

"I'd tell health care providers to do anything they can to help facilitate communication and build trust, recognizing they might not have done anything personally to violate that trust, but it's systemic, it's cultural," Jordan said. "We've overcome a lot of things culturally and just recognize that it is probably in the room."

Donna Winham and Lorraine Lanningham-Foster, assistant and associate professors of food science and human nutrition at Iowa State, respectively, also contributed to this research.