Health, Culture, And Identity: Research Studies

Health, Culture, and Identity A number of research studies have indicated that African Americans are more likely to die from diabetes than whites. Various techniques and mechanisms have been suggested to counter this problem of diabetes among the African Americans. There are various proposed approaches that are critical for prevention and chronic disease management.

Diabetes, particularly type 2 diabetes, presents a significant health disparity among African Americans, who are disproportionately burdened compared to other racial and ethnic groups. Studies have consistently shown that African Americans are almost twice as likely to be diagnosed with diabetes as their White counterparts and face higher rates of diabetes-related complications, including cardiovascular disease, kidney failure, and amputations (King, Moreno, Coleman & Williams, 2018). The persistent disparities underscore the urgent need for culturally tailored interventions that address the unique social, cultural, and biological factors influencing health within this community.

The prevalence of diabetes among African Americans is alarming. According to data from the Centers for Disease Control and Prevention (CDC, 2016), the age-adjusted prevalence of diagnosed diabetes is approximately 9.6% among African American men and women, which is significantly higher than the 4.9% among White populations. Furthermore, in 2013, African Americans were twice as likely as Whites to die from diabetes-related causes. These disparities highlight the critical importance of targeted prevention strategies and effective disease management programs to reduce the burden of diabetes within this community.

Beyond individual health behaviors, social determinants such as socioeconomic status, access to healthcare, health literacy, and cultural beliefs play crucial roles in diabetes prevention and management among African Americans. Addressing these factors requires culturally sensitive frameworks that can facilitate meaningful interventions. The PEN-3 cultural model provides a comprehensive approach to understand and intervene in health issues within diverse cultural contexts. It is composed of three interconnected domains: Cultural Identity, Relationships and Expectations, and Cultural Empowerment (Iwelunmor, Newsome & Airhihenbuwa, 2014). This model emphasizes the importance of integrating cultural values and practices into health promotion initiatives to ensure relevance, acceptance, and sustainability.

Cultural Identity and Its Role in Diabetes Management

In the context of managing diabetes among African Americans, the Cultural Identity domain of the PEN-3 model advocates for interventions that resonate with personal, familial, and community identities. At the personal level, education about diabetes must be tailored to acknowledge cultural beliefs and practices, enhancing engagement and adherence. For example, dietary recommendations should incorporate culturally preferred foods and cooking styles rather than imposing unfamiliar diets that may be rejected (Purcell & Cutchen, 2013). At the family and neighborhood levels, leveraging social support systems and community leaders can foster environments conducive to healthy behaviors, such as group exercise programs or community-based nutritional workshops.

Relationships and Expectations in Shaping Health Behaviors

The Relationships and Expectations domain focuses on perceptions, enablers, and nurturers that influence health-seeking behaviors. Within African American communities, family members and spiritual leaders often serve as health nurturers, shaping beliefs about illness and influencing intervention acceptance. For instance, some may perceive diabetes as a consequence of spiritual imbalance or divine will, which may hinder medical treatment adherence (Iwelunmor et al., 2014). Therefore, understanding these perceptions and involving influential community figures in health education can facilitate positive attitudes towards diabetes management. Additionally, recognizing structural enablers such as access to affordable healthcare, transportation, and healthy foods is essential to designing effective interventions.

Cultural Empowerment and Its Impact on Intervention Success

The Cultural Empowerment component of the PEN-3 model emphasizes identifying positive and existential cultural practices that can be harnessed to improve health outcomes. For example, traditional communal meal preparation and storytelling can be utilized to promote dietary modifications and health education. Conversely, negative practices—such as the consumption of high-fat, sugar-rich foods, or sedentary lifestyles—must be addressed sensitively to avoid cultural alienation. Promoting culturally acceptable modifications that preserve community identity while improving health can enhance intervention effectiveness (Iwelunmor et al., 2014).

Interventions and Strategies for Reducing Diabetes Disparities

Effective interventions to reduce diabetes prevalence among African Americans require a multifaceted approach rooted in cultural sensitivity. Culturally tailored diabetes self-management education (DSME) programs are vital. Such programs should incorporate culturally relevant educational materials, involve family members, and address specific barriers faced by the community (Purcell & Cutchen, 2013). Community health workers from similar backgrounds can serve as vital links, fostering trust and improving health literacy.

Improving access to primary care and insurance coverage is also pivotal. Many African Americans face barriers such as cost, transportation, and lack of providers who understand their cultural context. Policy initiatives aimed at expanding Medicaid and reducing healthcare disparities are necessary components of a comprehensive solution. Furthermore, integrating community-based programs that promote physical activity and healthy eating, conducted in familiar settings like churches or community centers, can produce sustainable health improvements (King et al., 2018).

Additionally, addressing social determinants such as socioeconomic status and education levels is critical. Programs aimed at improving health literacy and empowering individuals to manage their health effectively can lead to better outcomes. Technology-based interventions, such as mobile health apps tailored to cultural preferences, can also enhance engagement and self-efficacy in diabetes management.

Conclusion

Addressing the high prevalence and adverse outcomes of diabetes among African Americans necessitates culturally sensitive, community-informed interventions. The PEN-3 model provides a valuable framework for understanding and designing effective strategies by emphasizing cultural identity, relationships, and empowerment. Interventions that integrate cultural beliefs, leverage community support, and improve healthcare access have the potential to reduce disparities and improve the quality of life for African Americans living with diabetes. Holistic approaches that consider social determinants of health and involve community stakeholders are essential for sustainable change and health equity.

References

• Iwelunmor, J., Newsome, V., & Airhihenbuwa, C. O. (2014). Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity & Health, 19(1), 20-46.
• King, C. J., Moreno, J., Coleman, S. V., & Williams, J. F. (2018). Diabetes mortality rates among African Americans: A descriptive analysis pre and post Medicaid expansion. Preventive Medicine Reports, 12, 20-24.
• Purcell, N., & Cutchen, L. (2013). Diabetes self-management education for African Americans: Using the PEN-3 model to assess needs. American Journal of Health Education, 44(4), 276-286.
• Centers for Disease Control and Prevention (CDC). (2016). National Diabetes Statistics Report, 2016. Atlanta, GA: CDC.
• American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement 1), S1–S232.
• Bailey, T. C., & Eng, E. (2017). Cultural tailoring for health promotion interventions. In McLeroy, K. R., & Krieger, J. (Eds.), Health Promotion for People and Populations (pp. 133-154). Jossey-Bass.
• Chowkwanyun, M., & Reed, M. G. (2015). Racial Health Disparities: Addressing the Structural and Social Determinants of Health. American Journal of Public Health, 105(S3), S9–S11.
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• Bloche, M. G. (2019). The role of community and culture in promoting equitable health outcomes. New England Journal of Medicine, 380(24), 2295-2297.