Surviving the Perfect Storm of Diabetes in the World of the Schitsu'umsh

Abstract

Diabetes is a significant health problem in the United States which disproportionately affects Native Americans. Despite many new prevention and intervention programs, there has been a prolific increase in the incidence of diabetes among Native Americans. The purpose of this qualitative study was to explore the experience of Coeur d’Alene tribal members living with type 2 diabetes using a Heideggerian hermeneutic framework. Participants were recruited through the local diabetes educator at the tribal clinic using purposive and snowball sampling. Individual interviews were conducted with ten Coeur d’Alene tribal members whom had type 2 diabetes and were willing to share their stories of about living with diabetes. Participants ranged in age from 26-86. Interviews lasted from 25-90 minutes and focused on gathering stories about their daily life with their diabetes, and barriers and supports to their diabetes self-management. These became the data for hermeneutic interpretations. Individual transcripts were read and reread for initial themes. Next, comparisons between and across transcripts were done through interpretive emersion into the texts. Emerging themes and patterns were brought before a group of qualitative nurse researchers and doctoral students as a means of cross-checking and validating interpretations. Perseverance was the overarching pattern in the stories of living with diabetes in the world of Schitsu’umsh. The four themes that emerged under the umbrella of perseverance were valuing tribal traditions, being inattentively caring, struggling with disease burdens, and experiencing tensions in patient-provider relations. Living with diabetes in the world of the Schitsu’umsh was always a tenuous balancing act. There was an ever present dialectic tension between strengths and barriers underlying their daily struggles for balance. By increasing our understanding of Native American experiences of living with diabetes, collaborative partnerships can be developed with the tribes to address these barriers to diabetes self-management and to develop culturally relevant diabetes education programs. There is also a need to address cultural competence by the health care community and to work at eliminating biases and prejudice in our healthcare system. This work brings new cultural understandings of what it means to live with diabetes in one Native American group.