Assessing Informal and Formal Diabetes Knowledge in African American Older Adults With Uncontrolled Diabetes.
Kia Skrine Jeffers, Mary Cadogan, MarySue V Heilemann and 1 others
PMID 30690652WHAT IT FOUND
Older adults with uncontrolled diabetes built their own understanding through family stories and self-experimentation, not clinical advice.
They adjusted medications and diets based on what they saw work for others, often in unsafe ways. Clinicians rarely addressed these personal beliefs, focusing instead on labs and prescriptions.
Key findings
01Participants acquired diabetes knowledge primarily through personal and observed experiences, while viewing clinicians as limited to managing medications and monitoring labs.
02Participants engaged in self-directed medication adjustments, such as halving doses or switching to supplements, based on perceived bodily signals rather than medical instructions.
03Fear and perceived threats to physical integrity (amputation, blindness) drove participants' engagement with the disease, but these emotional burdens were rarely discussed with healthcare teams.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample size was small (15 participants), limiting the generalizability of the themes to all African American older adults with uncontrolled diabetes. The study relied on self-reported behaviors and perceptions; actual medication adherence and clinical outcomes were not independently verified. The perspectives of healthcare providers were not included, so it is unknown how clinicians actually assessed or addressed informal knowledge during encounters.
Declared interests
The first author received coupons from Abbott to offset the costs of product samples for participants' gift bags. Abbott is a major manufacturer of diabetes care products.
The easy way to misread this
Do not interpret these findings as evidence that patients are non-compliant due to ignorance. The study shows patients are actively constructing knowledge from their lived experience and social networks. Assuming a lack of education is the problem misses the fact that patients are making rational (if unsafe) adjustments based on the information they value most.