MAKING A DIFFERENCE--THE ROLE OF FAMILY IN NAVAJO DIABETICS

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This project investigates the roles of the family in facilitating disease management among Navajo individuals with type 2 diabetes, specifically: 1) the support given to diabetics by their families; and 2) how family support and Navajo philosophical concepts interact with two current diabetes interventions conducted by the Indian Health Service. In the previous MBRS research project, family support emerged as a critical factor in determining the extent to which Navajos with diabetes adhere to prescribed self-care behaviors such as diet change, weight control, and exercise. Certain traditional Navajo philosophical concepts also were associated with use of self-management techniques. The project will involve two distinct groups of respondents. The "Family Study" will involve ethnographic interviews and focus groups with members of 12 families (both diabetics and non-diabetics) who have one or more diabetic relatives to provide a depth of understanding of the dynamics of family support and use of traditional philosophical concepts in assisting diabetic family members. The "Intervention" will follow three groups of clinic patients with regard to change in their health status either following participation in one of two ongoing diabetes interventions, or after a similar period of time with non intervention. The interventions vary in the degree to which family involvement and tenets of Navajo philosophy are incorporated. In both parts of the study, the outcomes considered will include objective measures of diabetes management taken from the medical record, as well as self-management behaviors as reported by the Navajo diabetics. Hypotheses are: 1) that individuals whose families offer consistent, active and varied support will manage their diabetes better than those lacking such family support; 2) that families expressing traditional Navajo philosophical concepts such as those described above will be more likely to provide support for their diabetic relative; and 3) that interventions which target family-wide change, and involve active learning will have a greater impact on management behaviors and ultimately blood glucose than interventions which target individual change and stress didactic presentation. The findings in each of these areas of study will have significant ramifications for improving disease management and health care interventions for Navajos with diabetes.