A descriptive study in American Samoa: services for people with disabilities.

State agency service providers of persons with disabilities were surveyed and interviewed in American Samoa to describe and understand the level of services offered within the federal mandates and cultural context. Responses to the survey indicated that a majority of consumers do not request services or complete the application forms themselves. The interviews revealed an important aspect that was overlooked from the initial stages of the study: Many service providers did not have a conceptual understanding of self-determination as defined within a western context. We believe this cultural and contextual difference influenced how they responded to particular questions and perhaps how they engaged in providing services. This preliminary study opens the door for follow up investigations to determine the interplay of culture and federal regulations coinciding within a Pacific Island population.

Self-perceptions on the impact of diabetes among working adults: insights into disability prevention.

Effective diabetes self-management requires persons to be active participants in their care to prevent poor function and maintain independence and employment. Persons' perceptions and understanding of the potential impact of the disease could influence their self-management practices and success. This study explores perceptions on the impact of diabetes on future independence and employment. Findings indicate that 34% of participants believed diabetes would affect their employment, and 57% believed it would impact their independence. Logistic regression analyses showed that participants who believed that diabetes would impact employment were more likely to be younger, Native Hawaiian, and in poor physical health and to have been diagnosed with diabetes for a longer period of time. Those concerned with future independence were more likely to be younger and in poor physical and mental health. Understanding the associations between individual characteristics and perceived future abilities may enable healthcare professionals to tailor health education, promotion, and maintenance interventions to the needs of specific sub-populations of diabetics.

Perceptions of diabetes, barriers to disease management, and service needs: a focus group study of working adults with diabetes in Hawaii.

INTRODUCTION: Research about the support needs for and barriers to successful disease management of working adults with diabetes is limited. Our objective was to gain an in-depth understanding of how working adults in Hawaii perceive diabetes, barriers to disease management, and the services needed to keep people healthy and working. METHODS: From November 2008 through March 2009, we conducted focus group interviews with 74 employed adults with diabetes enrolled in the Hawaii Demonstration to Maintain Independence and Employment project. Responses to questions were analyzed within and across groups to identify recurring themes. A third layer of analysis examined themes across responses to all questions, specifically, how barriers related to identified service needs. RESULTS: Employed participants with diabetes experienced pervasive effects on their lives as a result of the disease, although they interpreted these effects positively or negatively. Barriers to disease management, such as additional health issues, social prejudice, and lack of social support, indicated a need to educate the general public about the disease. Participants identified needing social support from other people with diabetes, psychological support to address the emotional side of diabetes, and coordinated teams of specialists to address medication side effects and other health-related barriers to disease management. Many participants discussed the challenge of integrating diabetes management with work and family responsibilities and the need for monetary support. CONCLUSION: This study provides insight into how employed adults perceived their disease and what they perceived as challenges to successfully managing diabetes. The findings provide future directions for community and workplace diabetes initiatives.