Making Diabetes Self-management Education Culturally Relevant for Filipino Americans in Hawaii

Abstract

Purpose The purpose of this study was to identify the cultural val- ues, traditions, and perceptions of diabetes risk and self- care among Filipino Americans in Hawaii with type 2 diabetes that facilitate or impede engagement in diabetes self-management behaviors and education classes. Methods This qualitative study used 2 rounds of semistructured focus groups and interviews. Participants included 15 patients with type 2 diabetes recruited from a large health-maintenance organization in Hawaii and 7 health care and cultural experts recruited from the community. The taped and transcribed focus groups and interviews were coded thematically. Participants evaluated example materials for diabetes self-management education (DSME) with Filipino Americans. Results Several aspects of Filipino American culture were identi- fied as central to understanding the challenges of engag- ing in self-management behaviors and DSME: (1) undertaking self-management while prioritizing the fam- ily and maintaining social relationships, (2) modifying diet while upholding valued symbolic and social mean- ings of food, (3) participating in storytelling in the face of stigma associated with diabetes, and (4) reconciling spiritual and biomedical interpretations of disease causa- lity and its management. Respondents also emphasized therole of several qualitative aspects of perceived risk (eg, dread, control) in moderating their behaviors. Participants suggested ways to make DSME culturally relevant. Conclusions Awareness of cultural values and qualitative aspects of perceived risk that influence Filipino Americans' engage- ment in diabetes self-care behaviors and classes may help to improve teaching methods, materials, and recruitment strategies