Family and Friends Involvemnt in Self-Care for African Americans with Type 2 Diabetes
BACKGROUND: Diabetes is a common chronic condition that is associated with devastating health consequences for African Americans, who experience higher prevalence of diabetes and its complications. African American women, in particular, face a disproportionate burden of diabetes and its complications. Although there are well documented evidence-based therapies and self-management strategies to reduce morbidity and mortality from diabetes, use of these therapies among African American women is suboptimal. OBJECTIVE: To conduct a systematic review of the nature and effectiveness of social network (e.g. friends and family members) involvement in self-care for African American adults with type 2 diabetes (T2DM). Results of this review will be used to inform a culturally tailored intervention to enhance intrinsic motivation for engaging in recommended diabetes self-care behaviors among African American women with T2DM. METHODS: We conducted a systematic review of the published English-language literature (including PubMed, Web of Science, and CINAHL databases) using standardized search terms including African American, friends and family, social support, type 2 diabetes, and self-management to identify articles on the involvement of family and friends in self-management practices for African American adults with T2DM. We further identified those studies that focused on African American women. We also reviewed the references of each article selected for inclusion to identify other relevant articles. The text of each article was reviewed and content abstracted by one author (JLM). RESULTS: We reviewed 111 articles and identified 18 that met inclusion criteria; 5 of these focused on African American women. Characteristics of social networks that may influence diabetes self care and outcomes were identified, including several specific to African American women. Overall for African Americans, friends/family members who can serve as role models are more effective in helping person with diabetes be successful in obtaining glycemic control. African American women with diabetes obtained better glycemic control when they are satisfied with social support and when friends/family members are educated in diabetes care and can provide positive support. One recent study suggests that text messages may be considered an additional “friend” that can augment the support provided by members of the social network through reminders and opportunities to increase mastery. CONCLUSION: Friend/family centered approaches to supporting diabetes self-management can help African American adults improve glycemic control. Supplementing support with text messaging may enhance social support interventions. Additional research is needed to identify culturally-tailored social network interventions that result in improved diabetes outcomes for African American women.