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 Ame ricans with diabetes view their illness, and to develop a conceptual framew ork 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. T he mean age of the patients was 73 years, 58% were female, 63% had a compli cation from diabetes, and 58% were taking insulin. Patients were asked open -ended questions about how diabetes affected their fives and their attitude s 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 soci al context. Paradoxical, contradictory statements were common, expressing a mbivalence and uncertainty regarding the effect of the illness and the trea tment CONCLUSIONS Wide variation exists in the attitudes of older African America ns toward their diabetes and treatment. Patients frequently expressed ambiv alence coward the care of their illness. Providers should explore these iss ues and help patients resolve their ambivalence if patient preferences are to be respected in the overall treatment plan.