Spirituality and self-management of diabetes in African Americans

A major cause of morbidity and mortality in African Americans is type 2 diabetes. Although many factors contribute to this morbidity and mortality, one important factor relates to the complexity of self-management of diabetes. An important factor affecting self-management of diabetes in African Americans is spirituality. Spirituality plays a central role in the lives of many African Americans, and often provides a framework for health and illness. There is still little information, however, about how the spirituality of African Americans affects self-management of diabetes. Spirituality may enhance self-management by providing support and guidance. Spirituality may also at times reduce efforts toward self-management of diabetes for some who choose to relinquish self-management to God. The purpose of this study is to develop a theory about how the spirituality of African Americans affects their self-management of diabetes. This study used a grounded theory design. The sample consisted of 29 African American men and women, ages 40-75, with type 2 diabetes. Participants were recruited from a diabetes clinic and from churches in the Southeastern U.S., as well as through snowball sampling. Five of the participants were also ministers. Data were collected using minimally structured interviews and a demographic data sheet. The method of analysis was constant comparison. The core concept identified was self-management through a relationship with God. Participants fell into one of three typologies: (1) Relationship and Responsibility: God is in Background; (2) Relationship and Responsibility:; God is in Forefront: (3) Relationship and Relinquishing of Self-Management: God is Healer. These typologies varied according to how the participants viewed their relationship with God and the impact of this relationship on their self-management. They also varied according to their perceptions of how health care providers could help them manage their diabetes from a spiritual perspective. The major source of variation between typologies was religious affiliation. The spirituality of these African Americans was an important factor that influenced the self-management of their diabetes. It is therefore important for health care providers to be sensitive to the spiritual beliefs of their patients and help them use their spiritual beliefs in management of their illness.