Transcript Anthropological Investigations into Risk and Chronic Disease

“Nobody took time to tell me to watch
out for this”
Understanding risk and social support among
people living with type 2 diabetes
Julie Armin, MA (University of Arizona), Susan Shaw, PhD (U. of Arizona), Annamarie Schaecher, MA (U. of
Arizona), Sandra Leal, PharmD, CDE (El Rio Health Center), Jeffrey Petruski (U. of Arizona)
Presentation for:
Society for Applied Anthropology/Society for Medical Anthropology Meeting
March 28, 2008
Anthropological Investigations
into Risk and Chronic Disease

Individuals construct personalized
perceptions of risk (Armstrong 2005)

Many factors affect perceptions of risk
(Paisley et al 2002)
–
Education that ignores these factors
individualizes self-management “failures”
(Peterson 1996)
Anthropological Approaches to
Diabetes and Social Support

Complicate biomedical notions of disease
etiology (Scheder 1988, Schoenberg et al 2005,Rock 2003)

Recognize cultural and structural effects
upon self-management (Becker et al 1998, Becker 2001)

Examine social support from a “cultural”
rather than cognitive perspective (Dressler et al 1997,
Dressler and Bindon 2000)
Methods

Pilot study in Tucson, AZ
–
Qualitative research/participant
observation
– 13 participants (interviews and focus
groups)

Four-year NIH study in Springfield, MA
–
Quantitative and qualitative study
– N=400
Clinic Population
 27%
patients uninsured
 47% patients on Medicaid
 54% patients at or below Federal
poverty level
 38% patients under 15 years old
 Approximately 72% Hispanic, 10%
Native American
Findings
Safety net providers must acknowledge the longterm needs of diabetes patients
“When I left the hospital, they told me nothing. …they
didn’t give me a prescription for a meter or anything.
They gave me pills and said take these at this time
and don’t eat sugar and go see a doctor. And I told
them, well, I don’t have a doctor. And they said, well,
you need to get one. And that was it. That was all I
got from the hospital….
So I had no idea. And it took me, you know, about a
week and a half to get in and see a doctor. I had to
go through all kinds of stuff, get all my paperwork
together to go down to [the clinic] and get signed
up.”
--Jessica
“I knew nothing, and so he spent a lot of
time with me that first day, explaining
this is how foods work and this is what
you need to do and he gave me the
whole little meal plan and caloriecounting guide thing and all kinds of
stuff.”
--Jessica
Food is part of numerous
social interactions

“I’m just gonna have to quit eating! That’s
just what I thought! I’ll quit eating!”
--Betty

“You know, they like that lard and they like
this…so I’ve been a diabetic around fifteen
years and it’s taken me a long time to
change the style of cooking because of the
family…”
--Ana
Friends and family members take
on additional roles as caregivers
“He comes in because, well, my children
look after me. Sometimes he asks the
doctor questions in English. He
explains.”
--Imelda
Friends, family, and patients
themselves are fearful of diabetes
complications
“I say, no, just one. [in husband’s voice:] No, I
have to eat. You don’t have diabetes, I’m the
one that has diabetes. [her voice]: So that’s
the problem I’m having now. The other
problem is that his sugar isn’t controlled. I
don’t know. Even though he does his
exercises, his sugar is high. … sometimes
it’s too low. That’s the problem. He’s given
me two scares.”
--Lola
“…I saw him in a wheelchair with no legs. Both legs were
amputated. I thought it was him and at the same time it
was a different person from the one I used to see.”
He said, well, I’ll give you what I can. I’ll help you whatever I
can. He told me it was three first things I was going to lose:
my vision, my kidneys or my legs. He said, look at me: I
don’t feel no pain, no nothing. But I had to lose my legs...”
“…. where should I go? How do I buy [the glucometer]? So
finally in January, my new year’s resolution, I got my family,
my daughters and my wife. I told them, that I wasn’t getting
no help. That instead of getting better, it was getting worse
and worse. It’s getting to the point that I have to leave my
work. I have to leave my work.”
--Antonio
Final Thoughts

Post-diagnosis bodily disciplining process
is shaped by risk discourses and other
factors, including access to health care.
–

Support from family and friends is
supplemented by the clinic’s education and
case management
Perceived risk for complications affects
expressions of support and selfmanagement approaches
Acknowledgements

National Cancer Institute, grant 1R01
CA128455-01: The Impact of Cultural
Differences on Health Literacy and Chronic
Disease Outcomes

Social and Behavioral Sciences Research
Institute, University of Arizona