UNDERSTANDING BARRIERS TO EFFECTIVE CONTROL OF DIABETES IN NAVAJOS

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OBJECTIVE: To assess barriers to care, and acceptability and utility of existing and proposed interventions for Navajos with diabetes in the Shiprock area. Despite the information about control of diabetes and the availability of several types of interventions, diabetes is poorly controlled for many patients. The goal of this research is to assess the needs of the patients with diabetes, with the aim of proposing culturally acceptable, locally feasible interventions. METHODS: This project will involve the integration of qualitative and quantitative methods. Qualitative methods, including focus groups and ethnographic interviews, will permit Navajo diabetic patients to define the problems to research, including barriers to effective management and prevention of complications, how a successful intervention is defined, and what the salient elements of the interventions are. Quantitative techniques will include a survey of a larger group of patients to assess the magnitude and impact of the identified barriers within the population of diabetic patients sampled. Finally, medical record review will permit objective assessment of the degree to which individual patients are managing the progression of their disease. STUDENT INVOLVEMENT: Students will gain skill in research design and scientific method, sampling methodology, abstracting from medical records, construction of questionnaires, interviewing skills, epidemiology and statistics, and construction and evaluation of medical and behavioral interventions. Students will learn about the complications of diseases with genetic components, environmental factors and interactions between behavioral and medical aspects of health.