Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients

Abstract

IN BRIEF The purpose of this qualitative study was to examine providers’ perspectives on cultural barriers and facilitators to diabetes self-management (DSM) in Arab Americans to identify factors to enhance DSM education in the Arab-American community. The main barriers to DSM from the providers’ perspective were the disease itself and patients’ denial or refusal to recognize it, reflecting the stigma of the disease. Cultural aspects also included overlapping themes that both facilitated and presented barriers to DSM. These results suggest that DSM education for Arab Americans will be most effective if developed and delivered in a manner consistent with the cultural facilitators and barriers noted by providers.

A discussion paper on stigmatizing features of diabetes

“…A similar result was found in Palestinian children with T1DM, who perceived diabetes as a stigmatizing condition that spoiled their identity as a healthy individual, making them feel like an outsider and not a normal person (Elissa et al, 2016). A study performed in a U.S. Arab American community found that individuals often viewed diabetes as a weakness or breakdown (DiZazzo-Miller et al, 2017).…”

“…A similar result was found in Palestinian children with T1DM, who perceived diabetes as a stigmatizing condition that spoiled their identity as a healthy individual, making them feel like an outsider and not a normal person (Elissa et al., ). A study performed in a U.S. Arab American community found that individuals often viewed diabetes as a weakness or breakdown (DiZazzo‐Miller et al., ). Indian mothers of children with diabetes experienced diabetes‐related stigma when other people labelled their child as a “sick kid” (Verloo, Meenakumari, Abraham, & Malarvizhi, ).…”

“…Stigma in diabetes contributes to a hidden burden of the chronic condition affecting multiple aspects of life of those with diabetes (Abdoli, Abazari, & Mardanian, 2013;Benedetti, 2014;Broom & Whittaker, 2004;Nicolucci et al, 2013). Diabetes-related stigma may preclude diabetes management (Salamon, Hains, Fleischman, Davies, & Kichler, 2010), diabetes adherence (Mulvaney et al, 2011), multiple daily injections, participation in research studies, general health-seeking behaviours (DiZazzo-Miller et al, 2017;Jaacks et al, 2015) and insulin injections in unsanitary places (Abdoli, Doosti Irani, Parvizi, Seyed Fatemi, & Amini, 2013;Browne, Ventura, Mosely, & Speight, 2014;Shiu, Kwan, & Wong, 2003). In general, stigma may make individuals with diabetes frustrated by feeling different (Nurmi & Stieber-Rodger, 2012;Vermeire et al, 2007), keeping their diabetes a secret, avoiding self-management activities and seeking health-promotion choices (Abdoli, Doosti Irani et al, 2013;Elissa, Bratt, Axelsson, Khatib, & Sparud-Lundin, 2016;Fritz et al, 2016).…”

Keeping on target during a low-calorie diet: The experiences of participants in a type 2 diabetes reversal pilot

“…Within the home environment, the data revealed the heightened levels of temptations participants faced on a regular basis and the overt ridicule and sabotage they experienced as they did their best to engage in the recommended behaviour. Such stigma and ridicule thus increase the likelihood that the requisite self-care behaviours for remission may be compromised [40, 41]. Furthermore, consistent with previous research, the challenges participants experienced making the requisite dietary changes were intensified if their family members were not necessarily willing to follow their diet regimen and at the congregate meal sites they continued eating their regular meals [16, 35, 39, 42, 43].…”

Catching a Break: Accessibility, Empathy, and COVID-19

“… 16. For further discussion on race and diabetes, consider Bacon et al (2017), DiZazzo-Miller et al (2017), Hayashino et al (2018), and Reitblat et al (2016). Note (a) there is no such thing as “perceived” racism, (b) each of these articles discuss diabetes from the provider perspective, without patient voices included in the article-formations, and finally, (c) both previous points indicate a general lack of trust and respect in people’s lived experiences, expertise, and embodiment. …”