bidity and Mortality Weekly Report, 2000; Nelson and Bennett, 1989; Quiggins and Farrell, 1993; Stahn, Gohdes, and Valway, 1993). As the cohort of youngsters projected to be obese and to suffer with diabetes ages, the United States will experience an increase in elderly Type 2 diabetics suffering from cardiovascular disease, diabetic retinopathy, blindness, kidney damage and failure, neuropathy, and foot amputation (American Diabetes Association, 2000).
Four broad sets of factors affect whether and how a person takes action to prevent and control the threats associated with diabetes: (1) beliefs about the recommended action; (2) self-efficacy and related behavioral skills; (3) the social or interpersonal environment; and (4) the wider economic and physical ecology (see discussion in Chapter 2 on theory). The ecological framework provides both opportunities and barriers for action that both facilitate and constrain action-related beliefs, self-efficacy, and social influences. Low-fat and low-sugar foods will not be consumed if they are unavailable or unaffordable. Furthermore, an individual’s behavioral beliefs, sense of efficacy, and social factors will not affect choice of foods if there is no way to identify which foods are inappropriate. Efforts to enhance health through changing individual beliefs and practices must not ignore such contextual factors (Lorig et al., 1999; Gohdes et al., 1996).
Ecological factors aside, can we identify social/cultural and individual beliefs and practices related to diabetes prevention and treatment, and do these beliefs and practices have a direct relationship to behaviors that put individuals at risk for diabetes and its complications? Furthermore, is there evidence to support the hypothesis that the cultural and individual beliefs responsible for prevention behaviors differ among minority ethnic groups? Theories describing the processes underlying individual decisions and actions and models of communication would assert that beliefs about the procedures for the prevention and control of diabetes are