Diabetes in a Navajo community : a qualitative study of health/illness beliefs and practices

The increasing problem of Type II diabetes among Navajo people prompts this study in transcultural nursing. Among the Navajo people today, the prevalence of diabetes ranges between 10 and 20 percent, or about two to four times the national rate of five percent. Literature about the pathophysiology and epidemiology of diabetes is abundant; however, sociocultural studies of American Indian people's experience with the phenomenon of diabetes are few and have not been previously described. In this descriptive and exploratory research, transcultural nursing and sociocultural theories serve as a framework to identify Navajobeliefs and practices. It is argued that an understanding of cultural beliefs and practices about diabetes is necessary in order for nurses and other health care providers to offer efficacious and effective health care. This study takes place in a small community on the Navajo reservation. Proper steps were followed to seek permission for the study and to protect individual and community confidentiality. A modified ethnography using methods of semistructured interviews, participation, and observation in community activities, and field note taking is the methodology for data collection. In addition, this writer serves as a key informant, being a member of the Navajo Tribe and speaking the language. Content analysis of interviews and field notes is undertaken to develop themes associated with beliefs and practices concerning diabetes. Diabetes is viewed as a gestalt illness experience by Navajos, while it is viewed as a pathological entity by providers. Decision-making concerning health care utilization and compliance involves more complexity than is viewed by health care providers. Lack of understanding between patients and providers is a major factor contributing to many concerns expressed by both sets of informants. Recommendations are made to alleviate some misunderstandings between patients and providers, where diabetes is concerned. Increasing patient participation in learning situations, emphasizing preventive education among younger population, increasing nursing involvement at the community level, returning to more traditional methods of health promotion by running and eating more native foods, and effecting change at the tribal government and trading post levels are some specific recommendations made.