The Storied Nature of Health Legacies in the Familial Experience of Type 2 Diabetes

Abstract

In this study, we position families as pivotal anchors for coping with biophysical and psychosocial needs of members with Type 2 diabetes in two vital ways. First, we present narrative theory as a conceptual framework for moving beyond an individualistic understanding of health and healing. Second, we illustrate the efficacy of this position through an interpretive study of meaning-making about intergenerational diabetes among families living in rural Appalachian areas—contexts historically characterized by disproportionately high rates for numerous diseases including diabetes. Stories elicited from participants during interviews characterized their diabetes health legacies as dense and devastating. Our analysis illustrates how legacies evolve and shift across generations and shape how family members understand and manage diabetes, including the role of family members as intergenerational lynchpins and intergenerational buffers.

Notes

Drs. Manoogian and Harter share first authorship on this manuscript.

¹In the mid-1960s, the Appalachian Regional Commission identified a 200,000 square mile region bordering the northern, central and southern Appalachian Mountain chain as a geographic area that lagged behind the rest of the nation (ARC, 2008). Over time, many improvements have occurred, but unemployment and poverty continue to challenge the region and many health disparities exist for its underprivileged population (Behringer & Friedell, 2006). According to the last U.S. Census report, this population is primarily non-Hispanic Whites, with African Americans constituting the largest minority group (Pollard & Bureau, 2004). Given that Appalachian region includes counties from the entire state of West Virginia and only portions of 12 other states, most state data pertaining to diabetes fail to detail specifics that separate its incidence and prevalence risks for those in the Appalachian areas from the state as a whole. It is often challenging to detect the differences of type 2 diabetes risk factors that are realized by persons impacted by low socioeconomic status residing specifically in the Appalachian portion of the state. A 2004 telephone survey indicated that in four Appalachian Ohio counties, 8.3% of the population had diabetes, a rate approximately one-third higher than the national average at the time (ARHI, 2004). A follow-up study in 2006 included 11 Appalachian Ohio counties found a diabetes prevalence rate of 11.3%, a rate higher than national and state averages (ARHI, 2006).