Perceptions of Diabetes Education Among East African Immigrant Parents

Kristi Klee, DNP, MA, MSN, RN, CPN; Karen Thomas, PhD, RN; Deann Atkins, BSN, RN, CDE; Kathryn Ness, MD, MS


Pediatr Nurs. 2020;46(3):146-151. 

In This Article



The project employed a semi-structured interview format. The interviews were conducted with individual families to understand their perception of the diabetes management education received during the diagnosis hospitalization. The project was approved by the hospital Institutional Review Board as a quality improvement project. The interpreter obtained verbal consent from participants to record the interviews. Using a Somalian interpreter present with the family, interviews were conducted by the primary author over a three-month time frame.


The interviewer, in partnership with clinic staff, reviewed the weekly diabetes follow up appointment list to screen for patients who met inclusion criteria. Inclusion criteria included presence of caregiver(s) responsible for management of child's diabetes, child age birth to 16 years, native to an East African country, child diagnosed with type 1 diabetes and received diabetes education at the hospital in the previous two years, and child received follow-up care in the associated endocrinology clinic. Caregivers were approached at the end of their endocrinology appointment and verbally consented to participate in the interview.


During development of the interview questions, the primary author met with a hospital-based certified Somali interpreter to review interview questions and discuss culturally sensitive approach to interviewing East African families about their experience with diabetes management training. Interview questions included the following:

  • How many days of diabetes education did you receive at the hospital? Did it feel like enough time, how much time do you think is the right amount of time?

  • How confident do you feel in giving insulin?

  • Tell me about a typical day in your family and how you manage your child's diabetes (prompt for meals and insulin dosing).

  • Tell me about the education you received. What was most helpful? What was least helpful, and what would make these parts of the teaching sessions more helpful?

Interviews were initiated with an explanation of the purpose of the interview. Participants were told the interview was an opportunity for researchers to receive feedback on the parent(s)' perception of diabetes education and to learn what ideas they had to improve teaching sessions.

Data Collection

Interviews were conducted by the first author in the endocrinology clinic at the end of the family's appointment. Interviews included the certified interpreter present for the clinic visit. The interpreter asked the interviewer's questions in Somali and then gave the English interpretation of the interviewee's response back to the interviewer. To limit bias, the patient's chart was not reviewed prior to the interview so demographics, length of hospital stay for training, or current diabetes outcomes were not known to the interviewer. Interviews lasted 20 to 35 minutes, and were audio-recorded and transcribed in preparation for analysis.


The audio-recorded interviews were each transcribed into text format. Transcripts were independently read through several times by the primary author and an experienced coder. Two categories were agreed upon, adequacy of training and transition of care to home. Further analysis of the transcripts looking for themes within these two categories was accomplished using the online qualitative analysis software, Dedoose ( The primary author and experienced coder then carefully reviewed the content in each of the two categories and reached agreement as themes and subthemes emerged within the two categories.