Themes	Sub-themes	Quotations
Cultural nuances shaped perspectives on self-management	Use of herbal, complementary, and alternative remedies (CAMP)	“(My neighbor) is a diabetic too…. Sometimes she buys bush and give me some. I don’t know the name of it but it is supposed to help with sugar. So I use that.” (Female, age 52)
	Importance of maintaining local diet	“I take liberty every day. Right now I have … 3 plantains, 5 or 6 tanya, sweet potatoes, and I plan to take pig tail and cornmeal dumplings and make a big pot of peas soup…. You know the attitude I take. I live 70 years eating the same thing. What, now it’s going to kill me?” (Female, age 69)
Culturally-specific challenges were barriers to effective self-management	Stigma	“I think this needs to be more out in the open. Because you can have diabetes and control it and do everything that everybody else does. But it’s so secretive … everyone will treat you like you’re dying. There’s a stigma attached, yes. To being diabetic or having to take medicine for it.” (Female, age 54)
	Limited access to healthy food options/exercise	“Making the good food choices is hard. They’re simply not available in stores. Well, sometimes. Now, they tell me blueberries is good. I can eat that. But when you find that, it’s five dollars for a little bag so…” (Female, age 65)
Medical homes were rarely viewed as a primary source of diabetes education or support	Lack of educational resources	“I think there should be better resources for diabetics. Once you’re diagnosed there should be a place that you can go to for regular classes and monitoring. I can’t believe we don’t have that in this day and age. There isn’t even a dietician there (doctor’s office).” (Female, age 54)
	Self-adjustment of medication dosing and regimen influenced by friends and family	“Well, the doctor told me to take the insulin two times but my mother tell me—I want to know if this is right. He tell me to take twenty five units in the morning and twenty five in the night. But she said it’s too much, and just gives me fifteen at night. So that’s what I do.” (Female, age 43)
Fear of disease complications largely motivated or stalled self-management practices	Denial/Minimization	“I don’t want to think about it (having diabetes). Like I say, I don’t say I’m a diabetic. I only say my sugar is a little elevated. I don’t even want to call the word.” (Female, age 64)
	Resilience	“I see the struggle when people lose limbs. I play the flute and don’t want to lose fingers so I changed everything … I stopped the alcohol. And I cut back on all the starchy, Caribbean foods. You have to make up your mind that you’re going to back out of all those foods you grew up with. I grow my own vegetables now. And that is another way I can get exercise.” (Male, age 52)