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Keywords:

  • Grandmothers;
  • caregiving;
  • diabetes;
  • self-management;
  • Orem's Self-Care Deficit Theory of Nursing

Abstract

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Purpose: To compare the diabetes self-management activities of African American primary caregiving grandmothers before and after the initiation of caregiving and to compare the diabetes self-management activities of African American primary caregiving grandmothers to diabetic women who were not caring for their grandchildren.

Design: Using a cross-sectional, descriptive design, 68 African American women 55 to 75 years of age were recruited as part of a larger study examining the impact of caregiving responsibilities on the diabetic health of African American primary caregiving grandmothers. Each participant was asked the frequency of their performance of six self-management activities. Caregiving grandmothers were asked about these activities before and after the initiation of caregiving.

Results: Dependent and independent t-tests with Bonferroni correction were used to analyze the data. Statistically significant differences were noted in diet (t=4.400, p=.000) and self-monitoring of blood glucose (SMBG; t=3.484, p=.001) before and after the initiation of caregiving. For the caregiver versus non-caregiver comparison, statistically significant differences were noted in SMBG (t=−3.855, p=.000) and eye examinations (t=−3.211, p=.001).

Conclusions: The findings provide preliminary data to support further research examining the self-management activities of diabetic African American primary caregiving grandmothers. Diabetic African American primary caregiving grandmothers may have a decreased ability to integrate self-management activities into their daily patterns of living. Additional research is needed to determine what factors prevent this population from performing these tasks routinely.

Clinical Relevance: African American primary caregiving grandmothers were found to have more difficulty performing some of their self-management activities, which may severely impact their overall diabetic health.

African-American females experience a greater burden of diabetes and its complications, with twice the mortality rate of their White counterparts (Brancati, Kao, Folsom, Watson, & Szklo, 2000; Gary, Crum, Cooper-Patrick, Ford, & Brancati, 2000). The impact of diabetes is particularly problematic for the 25% of African American female elders over the age of 55 who experience the most severe outcomes from diabetes complications (American Diabetes Association [ADA], 2009). African American female elders are not only poorer than any others in the nation (Cawthrone, 2008), but they often are also burdened with multiple caregiving responsibilities, including primary responsibility for their grandchildren (Samuel-Hodge et al., 2000).

As of 2000, 8% of all African Americans lived with their grandchildren, with 52% of these grandparents assuming the role as primary caregiver (U.S. Census Bureau, 2003). A primary caregiving grandparent is defined by the U.S. Census Bureau as a grandparent who had primary responsibility for their coresident grandchildren younger than 18 years. Sixty-four percent of these grandparents were women, with African Americans representing 32% of this subset (U.S. Census Bureau, 2004). The southern region of the United States had the highest percentage (48%) of grandchildren living with a grandparent (U.S. Census Bureau, 2003).

Despite the fact that this caregiving role is neither voluntarily chosen nor anticipated, increasing numbers of African-American female elders have accepted the role (Goodman, 2003). They have done so because at least one of the child's biological parents often has a drug or alcohol addiction, is incarcerated, is infected with the human immunodeficiency virus (HIV), or, in recent years, is deployed with the military (Dowdell, 2004; Martineau & Wiegand, 2005; Ruiz, 2004; Weinstein & Takas, 2001). Caregiving of a grandchild has been associated with increased risk for both mental and physical health disturbances, including diabetes, hypertension, cardiovascular disease, insomnia, and depression (Kicklighter et al., 2007). Primary caregiving of grandchildren is challenging, time consuming, and sometimes overwhelming (Caliandro & Hughes, 1998; Roe, Minkler, Saunders, & Thomson, 1996). Caregiving can also negatively affect the grandmothers’ attention to self-care practices, resulting in poor health outcomes (Balukonis, D’Eramo Melkus, & Chyun, 2008).

Self-Care Management Activities

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Diabetes self-care activities are fundamental components of diabetes management. If self-care is inadequate, medical care is rarely effective (Suhl & Bonsignore, 2006). African American primary caregiving grandmothers with diabetes may have tremendous difficulty balancing their caregiving responsibilities and self-care regimens (Balukonis et al., 2008). Although anecdotal evidence has pointed to detrimental changes in self-management activities among this group, no studies were found that have compared the self-management activities of diabetic African American primary caregiving grandmothers before and after assuming the role of primary caregiver for their grandchildren. Additionally, few studies have compared the self-management activities of diabetic African American primary caregiving grandmothers to diabetic African American women who are not caregivers (Balukonis et al.).

Data were derived from a larger study investigating the impact of caregiver responsibilities on the diabetic self-management activities and diabetic health of African-American primary caregiving grandmothers. The specific aims discussed in this article were (a) to compare the diabetes self-management activities of African American primary caregiving grandmothers before and after the initiation of caring for their grandchildren and (b) to compare the diabetic self-management activities of African American primary caregiving grandmothers to diabetic African American women who are not the primary caregivers of their grandchildren. Comparisons of diabetic self-management activities before and after the initiation of caregiving coupled with comparisons between caregiver and non-caregiver were used to verify that any differences found were truly due to caregiving responsibilities.

Theoretical Framework

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Orem's Self-care Deficit Theory of Nursing (SCDTN) provided the framework for this study. One of the most widely used models for determining an individual's self-care deficit, needs, and the role of nursing, the main concepts of the SCDTN are therapeutic self-care demand, self-care agency, and self-care deficit (Orem, 2001). Therapeutic self-care demand is defined as a summation of measures required to maintain health, development, and well-being. Self-care agency comprises several power components necessary for the individual to take action to meet the individual's therapeutic self-care demand. Baker and Denyes (2008) stated that power components are “capabilities specific to health-related self-care actions” (p. 39). The SCDTN's fundamental premise is the lack of the self-care agency's ability to meet some or all of the components of therapeutic self-care demand. An increase in therapeutic self-care demand or a decrease in the individual's self-care agency may interfere with the attainment of the self-care requisites; thus, a self-care deficit exists (Orem). As a result of caregiving, the diabetic African American primary caregiving grandmother may experience alterations in power components and, thus, decreased self-care agency. This prevents her from performing self-care management activities (therapeutic self-care demand). Her diabetic health worsens, indicating that a self-care deficit has occurred.

Methodology

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

A nonexperimental, comparative design was used for this study to examine differences in African American grandmothers’ diabetic self-management activities before and after the initiation of primary caregiving for their grandchildren and to compare the self-management activities of diabetic African American primary caregiving grandmothers to diabetic African American women who are not caregivers. The specific aims focused in this article were part of a larger study examining the impact of caregiving responsibilities on the diabetic health of African-American primary caregiving grandmothers.

Sample

A power analysis was performed and found that a medium effect size (0.50 to 0.79) would result in a sample size of 68 to 128 at a power of 80% and alpha level of 0.05. A sample size of 68 was selected, which was large enough to detect a 1% difference (clinically significant) in HgbA1c, a main variable of the larger study. One hundred six diabetic African-American women were recruited in four counties in central Arkansas. Thirty-eight women did not meet inclusion criteria. No participants refused to be in the study. Sixty-eight participants (34 in each group) were eligible and completed the study.

Inclusion-Exclusion Criteria

Inclusion criteria were (a) African American females self-described as having origins in any of the racial groups of Africa; (b) 55 to 75 years of age; (c) self-reported diagnosis of type 2 diabetes; (d) residing in the state of Arkansas; (e) English speaking; (f) a Mini Mental Status Examination (MMSE) score of at least 25; and (g) cognitively able to understand and provide informed consent. In addition, 34 participants (half of the sample) were primary caregivers of a grandchild with the initiation of caregiving within the previous 3 years.

Grandmothers who were caregivers for anyone other than their grandchildren and persons with a known hemoglobin variant disorder such as sickle cell anemia or thalassemia were excluded from the study.

Measurement

Demographic characteristics Age, financial status, education, housing status, health insurance, and length of caregiving (for the caregiving group only) were collected using a researcher-developed questionnaire. This information was used to describe and compare the two groups.

Self-management activities A researcher-developed instrument was used to collect data on participants’ diabetic self-management activities, including (a) the number of days eating a healthy diet per week, (b) frequency of self-monitoring of blood glucose (SMBG) per week, (c) number of days engaging in at least 30 minutes of exercise per week, (d) medication adherence (number of times taking diabetic medications per week), (e) number of foot examinations per week, and (f) yearly eye examinations. Developed from an extensive review of the literature and clinical practice, the questionnaire was reviewed by a content expert to ensure face validity. Although several questionnaires were available to assess diabetes self-management activities, the researcher was unable to find one specific to diabetic caregiving grandmothers. Multiple studies have shown that caregiving grandparents have specific health needs (Butler & Zakari, 2005; Musil & Ahmad, 2002). Diabetes may further impact these needs. Therefore, the researcher felt an instrument specific to diabetic caregiving grandmothers was necessary to determine differences in their self-management activities due to caregiving responsibilities.

Participants were placed in either the caregiver group or the non-caregiver group. Participants were asked about the frequency of their diabetes self-management activities in the past 12 months. Additionally, the caregiver group was asked about their diabetes self-management activities prior to and after the initiation of caregiving in order to detect changes in these activities. For example, “In the 12 months prior to caring for your grandchildren, on average, how many times per week did you check your blood sugar? In the past 12 months while caring for your grandchildren, on average, how many times per week did you check your blood sugar?” Using Orem's SCDTN, this study quantified the power component “ability to integrate self-care actions into patterns of living” by determining the frequency of diabetes self-management activities before and after the initiation of caregiving. Self-care deficit was quantified as a statistically significant decrease in the self-management activities after the initiation of caregiving or in comparison to the non-caregiving group.

Procedures

Recruitment Participants were recruited by the use of flyers posted in local African American churches, the University of Arkansas for Medical Sciences (UAMS) employee areas, local senior citizen recreational centers, local daycare centers, and pediatric clinics at the Arkansas Children's Hospital. Booths were also set up at local health fairs and community events (e.g., Arkansas Diabetes Walk) to provide flyers on the study to potential participants who requested information.

Informed consent process Institutional review board (IRB) approval was obtained for this study through the UAMS IRB. The researcher or a trained research assistant met with prospective participants to explain the study and answer all questions. To determine basic eligibility, a screening tool was administered, which solicited information on the prospective participant's racial origin, age, diabetes diagnosis, and if they had a history of sickle cell anemia or thalassemia. The participants were asked if they could remember how they cared for their diabetes for the past 3 years. The MMSE was administered as a screening tool to determine the participant's ability to recall the purpose as well as the risks and benefits of the study prior to the initiation of the informed consent process. It was also administered to ensure that participants were not suffering from cognitive dysfunction, which could impair their memory and ability to recall their diabetes self-management activities. The MMSE is a widely used instrument that assesses cognitive function and takes approximately 10 minutes to administer. If it was determined that the participant was cognitively impaired (score≤24), the participant was excluded from the study. If all criteria were met, the study was explained to the participant. After answering all questions to the participant's satisfaction, written consent was obtained.

Administration of questionnaire Participants were provided with a questionnaire to obtain demographic data and information regarding their self-management activities. The researcher or research assistant read the questionnaire to the participant if requested. Completion of the questionnaire took approximately 15 minutes. All participants were provided with a $20 Wal-Mart gift card as a token of appreciation for their time and effort in the study.

Statistical Analysis

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

All variables were initially analyzed descriptively. The mean, median, standard deviation, minimum, and maximum values were calculated. Demographic data were analyzed and compared for equivalence using an independent t-test, Mann-Whitney U test, or chi-square test. For Specific Aim 1, a dependent t-test was used to compare differences in each diabetes self-management activity prior to and after the initiation of caregiving. For Specific Aim 2, data collected after the initiation of caregiving was used to compare differences in diabetes self-management activities between the caregiving and non-caregiving group and analyzed using an independent t-test. A Bonferroni correction was used to control for multiple t-tests. An alpha level of .001 was used for all statistical tests. All data were analyzed using the Statistical Package for the Social Sciences (SPSS), Version 17.0, Chicago, IL.

Results

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Demographics and Baseline Characteristics

Table 1 describes the equivalence data for each group. The age of the caregiving group ranged from 54 to 74 years, with a mean of 59.21 years (SD=5.22). The age of the non-caregiving group ranged from 55 to 75 years, with a mean of 63.03 years (SD=7.08). A statistically significant difference (χ2=33.882; p=.000) was noted in the housing status between the two groups, with the caregiving group more likely to live in a house instead of an apartment. There were no significant differences in age, financial status, education, or status of health insurance between the two groups. The length of caregiving for the caregiving group ranged from 1 to 3 years, with a mean of 1.87 years (SD=0.51). The number of grandchildren in their care ranged from 1 to 4, with an average of 1.76 grandchildren. The ages of the grandchildren ranged from 14 months to 17 years, with a mean age of 10.74 (SD=5.19).

Table 1.  Demographic Characteristics
 Caregiving N=34 (M/%)Non-caregiving N=34 (M/%)p value
  1. aIndependent t-test. bMann-Whitney U test. cChi-square test. dDoes not denote homeownership.

Age (yr)59.2163.03.140a
Financial status (monthly gross)  .180b
   $500–$99911.76%32.35% 
   $1,000–$1,49935.29%23.53% 
   $1,500–$1,99914.71%11.76% 
   $2,000 or above35.29%32.35% 
   Prefer not to answer2.94%0.00% 
Food stamps17.65%17.65%1.00b
Education level  .843b
  Less than high school20.58%14.70% 
Housing status  .000c
 Living in a housed100%70.5% 
 Living in an apartment0%29.4% 
Assistance with meds88.24%94.12%.242b
 or insurance   
   Medicaid17.65%20.59% 
   Medicare14.71%23.53% 
   Other insurance plan52.94%50.00% 
   Family member2.94%0.00% 
   No insurance plan11.76%5.88% 

Caregiver Self-Management Activities (Before and After)

Table 2 describes the differences in self-management activities of the caregiving group before and after the initiation of caregiving. Statistically significant differences were noted in the number of days eating a healthy diet and number of SMBG tests per week. The number of days eating a healthy diet decreased from a mean of 5.03 days/wk (SD=2.195) to 3.74 days/wk (SD=2.466, p=.000). SMBG decreased from a mean of 11.24 tests/wk (SD=9.032) to 5.44 tests/wk (SD=5.304), which is less than one test per day (p=.001). The standard deviation for SMBG is larger than anticipated due to outliers in the sample. For example, before the initiation of caregiving, one participant checked her blood sugar 28 times per week (or 4 times daily), whereas another did not check it at all. No statistically significant differences were noted in number of days engaging in at least 30 min of exercise, medication adherence, the number of self foot examinations per week, and the number of eye examinations per year.

Table 2.  Caregiver Self-Management Activities (Mean)
 Before initiation of caregivingAfter initiation of caregivingt value
  1. Note. SMBG, self-monitoring of blood glucose. p<.001.

Healthy diet5.033.74 4.400*
SMBG11.24 5.44 3.484*
Exercise3.743.590.401
Medication8.889.26−0.771 
Foot exams4.384.210.323
Eye exams1.290.942.098

Self-Management Activities (Caregiving vs. Non-caregiving)

Table 3 provides the results of the comparisons between the caregiving and non-caregiving groups. A statistically significant difference was noted in the number of SMBG tests per week (t=−3.855, p=.000) and in the number of eye examinations per year (t=−3.211, p=.001). The caregiver group had significantly fewer SMBG tests per week (M=5.44, SD=5.304) than the non-caregiving group (M=12.53, SD=9.317). The number of eye examinations was also significantly less in the caregiving group (M=0.94, SD=0.776) than in the non-caregiving group (M=2.03, SD=1.817). No statistically significant differences were noted in healthy diet, medication adherence, exercise, or foot examinations.

Table 3.  Self-Management Activities (Caregiver vs. Non-Caregiver; Mean)
 CaregiverNon-caregivert value
  1. Note. SMBG, self-monitoring of blood glucose. *p<.001; p=.001 (borderline).

Healthy diet3.746.44−2.64  
SMBG5.4412.53 −3.855*
Exercise3.592.381.845
Medication9.267.471.989
Foot exams4.215.12−1.201 
Eye exams0.942.03−3.211

Discussion

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Caregiver Self-Management Activities

African American primary caregiving grandmothers with diabetes encountered more difficulty adhering to a healthy diet and performing SMBG after the initiation of caregiving. Time constraints may prevent the grandmother from procuring, as well as preparing, healthy meals for herself and grandchildren, which would be consistent with the literature (Butler & Zakari, 2005; Whitley, Kelly, & Sipe, 2001). Caregivers often consume more saturated fats than women who are not caregivers (Lee, Colditz, Berkman, & Kawachi, 2003; Whitley et al.). The cost of healthy foods may be a factor. Healthy foods often cost more than high-calorie, high-fat foods (Inglis, Ball, & Crawford, 2008). An additional explanation, with more people to feed, the cost of preparing healthy meals increases. The primary grandmother may feel it is most cost efficient to cook an inexpensive meal such as spaghetti, for example, that will feed the entire family while ignoring her own health needs (i.e., decreased carbohydrate diet). Lastly, the caregiving grandmothers may be unable to prepare healthy meals due to the lack of physical energy as a result of caregiving responsibilities. Multiple studies have noted that grandmothers report lack of time for self due to caregiving responsibilities (Caliandro & Hughes, 1998; Roe et al., 1996).

The number of SMBG tests was significantly decreased in the caregiving group after the initiation of caregiving to less than one test per day, which does not meet the ADA standards of monitoring blood glucose at least daily. The grandmothers attempted to justify this by noting that they gauged their blood sugar levels by how they felt, stating, “I know what it runs” or “I know how I feel when it's [blood sugar] too high or too low.”

Since diabetics can often become acclimated to high blood glucose, healthcare providers need to stress the importance of SMBG to ensure effective treatment regimens. However, diabetic African American primary caregiving grandmothers may have difficulty performing SMBG due to decreased financial resources. Whitley et al.'s (2001) study of 100 grandmother or great-grandmother caregivers found that 85% of their sample relied on public assistance as their primary source of income, with those who were employed or receiving retirement funds still unable to fully support their grandchildren. However, this study found no evidence to support that financial difficulties prevented the grandmothers from performing SMBG due to caregiving in this sample.

Self-Management Activities (Caregiving vs. Non-Caregiving)

Diabetic African American primary caregiving grandmothers had more difficulty performing SMBG than diabetic African American women who were not caregivers, which may be the result of financial constraints due to caregiving responsibilities. Although there was no statistically significant difference in income between the caregiving and non-caregiving group, Dowdell (2004) stated that the financial burden of caregiving for grandchildren can be extremely high. Caregivers often do not have enough money to support themselves and their grandchildren (Whitley et al., 2001).

An additional finding consistent with the literature was that these caregivers had less visits to their healthcare provider for eye examinations than the non-caregiving group. Several studies have identified difficulties primary caregiving grandmothers have in keeping their appointments with their healthcare providers due to time or financial constraints (Butler & Zakari, 2005; Minkler, Roe, & Price, 1992). However, most of the literature describes visits to primary care providers and not to specialists. This study's findings suggest that diabetic caregiving grandmothers have difficulty either making or keeping appointments with their eye doctor.

Limitations

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Several limitations of the study must be identified. First, all participants were “self-reported” type 2 diabetics. The responses to the questionnaires were dependent on the participants’ abilities to recall the self-management activities; therefore, recall bias is a possible limitation of the study. Obtaining data was problematic for some of the caregivers as they had to recall diabetic self-management practices 2 to 3 years prior to the date of data collection. Another limitation is the differences in administration of the instruments. The caregiver group's questionnaire was longer than the non-caregiver group due to questions regarding caregiver status and self-management activities before and after the initiation of caregiving. It is unknown if the caregiver questionnaire was too lengthy and subsequently fatigued the caregivers, impacting their responses.

History is also a limitation of the study. It is quite plausible that factors unrelated to caregiving impacted the caregivers’ ability or motivation to perform diabetes self-management activities. Additionally, the participants were recruited from counties in central Arkansas and may not be representative of more rural areas in the state. Lastly, the researcher-developed questionnaire may be a possible limitation of the study. Although the researcher developed the questionnaire using an extensive literature review and a content expert, the instrument was not tested for reliability and validity prior to use.

Implications for Clinical Practice

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Comparing the diabetic self-management activities before and after the initiation of caregiving provided evidence of the impact of caregiving responsibilities on these activities on diabetic African American primary caregiving grandmothers. Further support was acquired with the comparisons of self-management activities between the caregiving and non-caregiving groups. African American primary caregiving grandmothers with diabetes may be at serious risk for complications of diabetes because of their inability to perform self-management activities. Healthcare providers must be diligent in educating this population on the importance of performing diabetes self-management activities to delay or prevent diabetes complications, possibly through church-based education classes. Samuel-Hodge et al. (2006) found that church-based diabetes self-management education programs were effective for African Americans with type 2 diabetes. As the foundation of diabetes self-management (Wu, 2005), a healthy diet rich in fruits and vegetables while low in saturated fats is recommended every day (ADA, 2009), which may increase physical energy levels much needed in the primary caregiving grandmother. It is recommended that the diabetic client administer SMBG at least daily to “help make day-to-day decisions for managing glucose” (U.S. Food & Drug Administration, 2002). To assist in time management, clinicians can instruct this population to perform SMBG when they awake but prior to their grandchildren rising. Lastly, to monitor eye health, it is imperative that healthcare providers stress the importance of yearly eye examinations. Since time constraints often prevent caregiving grandmothers from seeking health care, the establishment of “grandma & me” community wellness clinics providing examinations to the grandmother as well as the grandchild may provide a much needed resolution to this need.

Implications for Future Research

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Despite the limitations of this study, the findings lay a foundation for future research examining the self-management activities of diabetic African American primary caregiving grandmothers. Several recommendations are suggested for future research. First, it is recommended that the questionnaire be evaluated for reliability and validity and to further refine it. Research is needed to determine what factors prevent this population from performing these tasks routinely. Several additional questions have emerged after examining the results of this study that may be answered with future research. Because of caregiving responsibilities, diabetic African-American primary caregiving grandmothers may have a decreased ability to integrate self-care actions into their patterns of living. The caregiver's motivation for action may also be altered due to fatigue and time constraints. By educating these clients on the importance of performing their diabetes self-management activities and how to manage their time, this population may delay the progression of diabetes and diabetes-related complications. Future research may be directed toward discovering what factors influence when this population checks their blood glucose, how fatigue and time constraints play a role in their meal choices, or how the age of the grandchildren impacts their ability to perform diabetes self-management activities.

The development of tailored interventions will assist in promoting the diabetic health for this population. Church-based interventions such as nutrition classes focusing on preparing quick, healthy meals for both grandmother and grandchild or formal exercise classes with childcare can be offered before or after choir rehearsal (for example) to decrease time and financial constraints. According to Campbell et al. (2007), “African-Americans, women and older adults are more likely to identify themselves as religious compared to other population segments” (p. 214). This type of intervention would also assist this population in developing support groups or social networks and may provide a platform to stress the importance of taking care of their diabetic health by engaging in diabetes self-management activities.

Conclusions

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

Comparisons of the diabetic self-management activities before and after the initiation of caregiving show the impact of caregiving responsibilities on these activities. The comparisons of self-management activities between the caregiving and non-caregiving groups further emphasize this impact. Because of caregiving responsibilities, diabetic African American primary caregiving grandmothers may have a decreased ability to integrate self-care actions into their patterns of living. Additional research is needed to determine the caregiver's motivation for action and if it is altered due to fatigue and time constraints of caregiving. Educating these clients on the importance of performing their diabetes self-management activities and providing tools for effective time management may delay the progression of diabetes and diabetes-related complications will consequently increase their longevity and quality of life.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References

The authors would like to thank the following for financial support for this project: John A. Hartford Building Academic Geriatric Nursing Capacity Program; Sigma Theta Tau Gamma Xi Chapter; Arkansas Nurses Foundation; and the University of Arkansas, College of Nursing.

References

  1. Top of page
  2. Abstract
  3. Self-Care Management Activities
  4. Theoretical Framework
  5. Methodology
  6. Statistical Analysis
  7. Results
  8. Discussion
  9. Limitations
  10. Implications for Clinical Practice
  11. Implications for Future Research
  12. Conclusions
  13. Acknowledgements
  14. Clinical Resources
  15. References
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