IntroductionDiabetes affects 25.8 million people throughout the United States, about 8.3 percent of the population (Hawkins, 2015). Nearly 19 percent of African-Americans 20 years and older have diabetes and yet self-care is performed at a lower rate for this group (Kleier, 2014). African Americans have higher rates of diabetes and are four to six times more likely to develop blindness and vascular disease or experience lower-extremity amputation and kidney disease than Caucasians (Carter, 2013). Low socioeconomic status can limit access to health care and needed medications, and in general, African Americans and Latinos experience higher poverty and unemployment rates than other ethnic groups (Hawkins, 2015). Men of color have the poorest health outcomes and are more likely to be hospitalized or die from complications related to diabetes (Hawkins, 2015). Diabetes is also one of the leading causes of end-stage renal disease for African Americans (Kleier, 2014). 

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Self-management is time-consuming and includes strict adherence to meal planning, exercise routines, and caring for eyes, feet, and kidneys. Diabetic patients must measure and control their blood pressure, blood lipids and glucose values while adhering to the prescribed medication schedule. Latino and African American men often wait until symptoms become too painful and severe before seeking treatment (Hawkins, 2015). 

Structural issues like getting time off work and transportation issues are deterrents to getting help. The men in Hawkins’ 2015 study found they lacked the resources to cover the cost of glucose screening supplies, medical visits, and prescription drugs, as well. These systemic barriers can result in adverse health outcomes among African-Americans. For example, African-Americans are 2.7 times more likely to face a lower-limb amputation, almost 50 percent more likely to develop diabetic retinopathy, and 2.6 to 5.6 times more likely to experience kidney disease (Kleier, 2014).

One of the goals of the Healthy People 2020 initiative is to address the diabetes-related factors that contribute to decreasing the quality of life among those diagnosed with diabetes or those at high risk for developing diabetes. Healthy lifestyle choices are the key to controlling diabetes, yet many face obstacles that reduce available options. Self-management of diabetes includes the monitoring of glucose and maintaining a healthy diet, exercising, and adherence to pharmacotherapy and other forms of a foot, dental and eye care; engaging in these self-management duties can reduce the risk of future diabetes-related complications (Kleier, 2014). Therefore, increasing access to information about diabetes prevention and management for African Americans is vital to improving health and quality of life.

Psychosocial, structural and educational factors affecting self-management
Previous research has illustrated that a patient’s attitude or outlook is a significant predictor of self-management (Kleier, 2014). Kleier’s study aimed to identify the significant factors that hinder efforts to improve attitude. The researchers hypothesized that consistent access to information on self-care, treatment options, and frequent interactions with health care professionals are reported to be the leading barriers reported many African Americans (Kleier, 2014).

Hawkins et al. (2015) explored the influence of psychosocial factors on the self-management of diabetes and health care utilization in men of color with type 2 diabetes. Twenty-two participants (nine African American men and 13 Latino men) participated in focus groups conducted in community settings (i.e., churches) located in Detroit, Michigan. During discussions, the participants mentioned the following as facilitators to healthy behaviors to the management of diabetes: social support, immigration status, access to resources, structural barriers, and the patient-provider relationships (Hawkins, 2015). Social support from spouses, children and family members were reported to be the most important means of motivating the men to practice self-management techniques (Haekins et al., 2015).

Kleier et al. (2014) enrolled 100 adults to participate in the study; the majority of the sample were female (n=73). Ninety percent of the survey population was reported to be either overweight or obese. Participants rated their understanding of both the diagnosis and treatment of diabetes as “highly understood”(Kleier et al., 2014). Researchers found that many of the participants had not attended formal diabetes informational sessions. Therefore, health professionals should be concerned that high rates of self-reported understanding of self-management techniques may not be accurate.

Since many people do not understand what carbohydrates are, Carter et al. (2013) urge nurses to find ways to explain which foods are higher in carbohydrates (like potatoes and bread rather than just sugary sweets) so African American patients can make better dietary choices. Carter (2013) insists nurses need to consider the patient’s circumstances when recommending exercise, as well. Asking them if they have a safe place to walk or finances to join a gym may open up a discussion to find useful alternatives.

Information dissemination strategies should incorporate video and audio messages since African Americans from low socioeconomic levels tend to have lower literacy rates. Carter et al. (2013) explored various educational strategies for teaching self-management of diabetes and found that those that were culturally developed were more efficient. Successful programs included stronger social support, guidance in establishing goals, education about available community resources, and weekly telephone follow-up calls to offer reminders and identify complications. Carter et al. (2013) also found that tailoring education on managing type 2- diabetes had lead to increased rates of self-care in African Americans. Culturally appropriate interventions that targeted lifestyle choices like diet and exercise were found to help people reach their goals while improving dietary choices and foot care (Carter, 2013). In-home, nurse-delivered, individualized counseling interventions with older rural African-American women with type 2 diabetes also served to increase patient and nurse collaboration and helped patients manage their symptoms more successfully (Carter, 2013).

Conclusion
In sum, researchers studying diabetes in African Americans have found that social support is critical to self-management. Symptom-focused interventions that take place in the home where nurses listened closely, and participants were encouraged to reiterate what they had learned are especially effective in reducing stress and improving self-care practices and quality of life (Carter, 2013). Public health interventions targeting this population should seek to facilitate family support and improve patient-provider interactions and trust (Hawkins, 2015). Providing culturally relevant educational sessions that facilitate discussion and a safe space to talk about barriers in practicing self-care is a strategy that may help practitioners work towards the Healthy People 2020 goal of reducing the burden of diabetes and improving the quality of life.

    References
  • Carter, B. M., Barba, B., & Kautz, D. D. (2013). Culturally tailored education for African Americans with type 2 diabetes. Medsurg Nursing, 22(2), 105.
  • Hawkins, J., Watkins, D. C., Kieffer, E., Spencer, M., Espitia, N., & Anderson, M. (2015). Psychosocial factors that influence health care use and self-management for African American and Latino men with type 2 diabetes an exploratory study. The Journal of Men’s Studies, 1060826515582495.
  • Kleier, J. A., & Dittman, P. W. (2014). Attitude and empowerment as predictors of self-reported self-care and A1C values among African Americans with diabetes mellitus. Nephrology Nursing Journal, 41(5), 487.