Date of Award

2018

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Christine Blake

Abstract

Diabetes is a devastating disease that can affect an individual’s health and quality of life, but if managed properly, individuals with diabetes can have a good quality of life. Diabetes strikes African American men at a high rate. This study used a qualitative design to explore African American men between the ages of 40-85 with type 2 diabetes (T2DM) and their definition of diabetes and motivation, their experience of living with diabetes, their self-management behaviors, their motivations for managing diabetes, and what they and healthcare providers believe motivates them to self-manage diabetes and to attend diabetes self-management education (DSME) programs. In-depth interviews were conducted with 22 African American men from the Piedmont area of South Carolina and 6 healthcare providers from various disciplines that treated African American men with T2DM.

The Self-Determination Theory was used as a framework to explore their motivations. Data were collected over a 6-month period and consisted of field notes, memos, reflections, and dually recorded, in-depth interviews. Data analysis consisted of using NVivo 10 to assist with data management and storage. Interviews were transcribed verbatim and analyzed using thematic analysis and an iterative process to develop the major themes. Results indicated that participants defined diabetes as “a mean nasty disease” and described initial reactions of being diagnosed with diabetes as disbelief, anger, scared, and denial. Participants described living with diabetes as challenging, but “I got it under control” and had differing opinions on healthcare providers with some having great respect and others expressing distrust. Having family support, trying to practice good health and wellness behaviors, and dealing with the cost of diabetes medications were common concerns of most participants. Motivation was defined by participants as having “drive” or “attaining a goal”. For most participants, being there for family was their primary motivating factor for managing diabetes. No participants expressed pure intrinsic motivation for managing their diabetes as simply doing it for joy. Two participants were amotivated and did not have intentions of managing diabetes, but most had extrinsic motivation for managing diabetes such as wanting to see grandchildren grow-up or avoiding needles for insulin. Many participants believed that making diabetes classes more interesting and convenient could improve motivation to attend DSME classes. Healthcare providers viewed their roles as “cheerleaders”, “coaches”, and “lifestyle changers”. Most healthcare providers used fear tactics to motivate participants to manage diabetes such as emphasizing possible consequences of poorly managed diabetes as sexual dysfunctions and comorbidities. Additionally, healthcare providers believed that involving family, decreasing cost, empowering individuals, recognizing the importance of culture, and having more time with diabetic patients would improve participant’s motivations for managing diabetes.

In conclusion, diabetes has an enormous impact on the global, national, state, community, and individual levels. Individuals living with diabetes face many challenges such as emotional burdens, struggles to manage and cost of managing the disease. It is important to understand the lived experiences of African American men living with T2DM, their motivations to manage diabetes and to attend DSME programs, and the mutual perceptions of motivation of African American men and health providers that treat African American men with T2DM to implement culturally sensitive DSME strategies and to help improve their diabetes self-management outcomes.

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