Developing a conceptual framework for understanding illness and attitudes in older, urban African Americans with diabetes

PURPOSE This study was conducted to better understand how older African Americans with diabetes view their illness, and to develop a conceptual framework for approaching their care. METHODS Researchers conducted interviews of 19 African American patients 65 years or older who attended clinics at an urban academic medical center. The mean age of the patients was 73 years, 58% were female, 63% had a complication from diabetes, and 58% were taking insulin. Patients were asked open-ended questions about how diabetes affected their fives and their attitudes toward treatment Data were analyzed through a grounded-theory perspective. RESULTS Patients showed variation in the degree to which they believed that diabetes affected their fives and how aggressive they wished treatment to be. Themes included issues of quality of life, health beliefs, and the social context. Paradoxical, contradictory statements were common, expressing ambivalence and uncertainty regarding the effect of the illness and the treatment CONCLUSIONS Wide variation exists in the attitudes of older African Americans toward their diabetes and treatment. Patients frequently expressed ambivalence coward the care of their illness. Providers should explore these issues and help patients resolve their ambivalence if patient preferences are to be respected in the overall treatment plan.