Grant: Doctoral: Vanier Canada Graduate Scholarships

Chronic diseases are some of the major causes of illness and death internationally and their prevalence continues to rise. Dietary habits are among the most important and modifiable causes of chronic diseases, with changes producing significantly improved outcomes in such diseases as type 2 diabetes (or diabetes). Diabetes is very prevalent amongst persons of Indian descent in Trinidad, with similar prevalence rates found amongst the First Nations peoples in Canada and Native Americans in the United States. For Indian Trinidadians, as for First Nations peoples and Native Americans, complex relationships between cultural identity, history, memory, religion and power are instantiated through symbolic features of their dietary practices. Though these populations differ greatly and have been affected by different historical forces, they all display considerable resistance to dietary change. They are described similarly in the literature as “noncompliant”, a term with moral overtones that may negatively impact the medical care they receive. Given the complex significance of diet, transformations require not the “compliance” of an individual patient, but of complex interconnected systems of patient “agency”: regular family routines, established networks of friends and community relations. I will perform qualitative research to explore the interaction of medical notions of compliance and patient notions of agency in the context of family, social networks and ethnic community. Integrating epidemiological and ethnographic methods, I will explore the perceptions and perspectives of both doctors and patients to re-frame the management of diabetes. The outcome I intend is a series of recommendations to assist medical practitioners that are culturally compatible with the Trinidad cultural space. I intend for these results to provide a general framework that can be extrapolated for the lifestyle management of other chronic diseases in diverse cultural contexts.