Multifaceted Stressors of Natives Living with Type 2 Diabetes: Perspectives of cis-gender binary females and males

Abstract

In the US, 14.7% of Native Americans have diabetes and are the highest-ranking racial/ethnic group for the prevalence of diabetes (CDC, 2020). Native American women have the highest diabetes prevalence accounting for 14.8% of diabetes diagnoses in the US (CDC, 2020). The collective and cumulative stress of all traumas (historical, intergenerational, adverse childhood experiences, and present-day trauma) have been linked to the development of type 2 diabetes for Indigenous people (Elm et al., 2019; Lewis et al., 2021, Scott et al., 2011; Walls et al., 2017). There is a need for new scientific knowledge informing strategies to improve clinical practice and research addressing the multifaceted stressors of Native American adults living with type 2 diabetes with an understanding of gender-specific roles attributed to Indigenous stress burden. Aim: To explore the similarities and differences of psychosocial stressors identified by Native American men compared to Native American women living with type 2 diabetes. De-identified data were utilized from the qualitative stage of Maawaji’ idi-oog mino-ayaawin. Data were organized using inductive content analysis derived from the nineteen categories of the Continuum A.I. Stressor Model, which encompasses present-day trauma and includes collective traumas of historical, intergenerational, and adverse childhood trauma (Elm et al., 2019). Females discussed most stressors more frequently than males. The most frequently discussed stressor was daily hassles and battles – health management, including stress related to exercise, nutrition, and stress management across all groups. Females also frequently discussed stressors of family struggles, social roles, and lateral oppression in healthcare contexts. In a comparison of stressors of Natives living with type 2 diabetes between females and males, it is evident that women seem to carry a heavier stress burden compared to males. Further in-depth exploration is needed in research and healthcare practice to identify the complex impacts of colonization and trauma and how they are related and manifest presently in the stress burden of Native women living with type 2 diabetes.