Cuban Americans and type 2 diabetes : describing self-management decision making using an empowerment framework

This qualitative descriptive study examined the day-to-day self-management decision making in Cuban Americans with type 2 diabetes including major decisions, resources and influences to decisions, desired amount of control and advice, and the role of the health care provider. The sample consisted of 20 English speaking, Cuban-American adults between the ages of 45 to 65 years. The mean A1C was 7.49%; mean diabetes duration 4.5 years. Data were collected through discussion of a short self-management decision-making scenario, a semi-structured interview, and demographic questionnaire. Interviews were analyzed using Miles and Huberman’s method of content analysis framed by the concepts of Paolo Freire’s empowerment theory. Self-management tasks of exercise, diet, medication administration, and glucose monitoring were all thought to be important by the participants. Cost, time, structural barriers, social environment, symptoms, and medical information influenced self-management decisions. Challenges included negotiating social occasions, acknowledgement of friends and family, structural barriers, and available resources. Most participants felt they had some personal control and responsibility in decision making. Health care providers, friends, and family were sources of advice. Attempts were made to integrate health care providers’ advice into day-to-day self-management. The aspects of Freire’s theory (dialogue, reflection, and praxis) were reflected in participants’ descriptions of self-management decisions. The findings of this study suggest the challenges of balancing self-management practices with everyday life should be considered when caring for Cuban Americans with diabetes. Culturally sensitive interventions that facilitate the integration of glucose monitoring, exercise, diet, and mediations need to be developed.