Introduction
The U.S. territory of American Samoa has a disproportionate number of people with type 2 diabetes mellitus compared with neighboring Samoa and the U.S. mainland. The purpose of this research was to study perceptions of diabetes among people with type 2 diabetes in American Samoa in order to design culturally appropriate interventions to prevent and manage diabetes effectively.

Methods
Seven focus groups were held with 64 participants at a primary health care facility and a nearby workplace in American Samoa. These focus groups were conducted in the Samoan language and explored perceptions of diabetes, including its meaning, etiology, and the illness experience. Participants were people with diabetes at the health care facility and their family caregivers.

Results
Our systematic analysis of the translated transcripts showed that American Samoans with type 2 diabetes experienced individual, familial, cultural, and environmental stress. They also associated environmental and familial stressors with the worsening of symptoms and increases in blood glucose levels. Although participants believed that stress within the family worsened diabetes symptoms, family members figured prominently as primary caregivers.

Conclusion
Interventions aimed at improving diabetes management in American Samoa should emphasize family involvement coupled with education and methods to reduce caregiver burden, given the chronic, lifelong nature of diabetes.