Black women and eating behavior change trajectories after diagnosis with type II diabetes: What facilitates and what constrains change?

Introduction: Black women are disproportionately at risk for type II diabetes-related complications and fatality. Healthy eating behavior changes (EBCs) are prescribed to treat diabetes and prevent complications, yet are demonstrably difficult to follow. What facilitates EBC, even briefly, among women newly diagnosed with diabetes? What contributes to EBC reversion? Methods: This qualitative study explored how 15 Black women recently diagnosed with diabetes experienced making EBCs upon diagnosis and over time. Each woman was interviewed three times over nine months. Interviews covered past and current eating behaviors, facilitators and constraints to making EBCs. Data were analyzed using the constant comparative method, generating EBC trajectories for each woman from diagnosis through the study. Results: Participants discussed three major EBC areas: meal content, portion control, and timing of eating episodes. Women differed in extent, constancy, and longevity of EBCs with trajectories categorized by those who: (1) “respected diabetes”, overhauled diet and maintained changes; (2) were “on the mend”, made specific EBCs with varying constancy; (3) made extensive EBCs immediately following diagnosis then waned; or (4) made minimal or no EBCs after diagnosis. Key themes influencing EBC included agency over irregular meal times and content, beliefs about fatalism/prevention of complications, having a health professional to comfortably communicate with, stress, and uncertainty with recommended practices. Themes shifted in importance and relevance throughout EBC trajectories. Discussion: EBC trajectories highlight the dynamic and static nature of immediate and upstream factors affecting EBCs for Black women recently diagnosed with diabetes, informing public health interventions to prevent diabetes-related complications.