OBJECTIVE: To determine inner city American Indians' perceptions of diabetes; find out how they manage their disease; and identify what health care improvements may be necessary for this population. DESIGN: Eight focus group discussions conducted with diabetic inner city American Indian adults. SETTING: Focus group discussions led by moderator using open-ended questions with prompts. PARTICIPANTS: Eligibility criteria include age (> or = 18 years), a self-reported diagnosis of diabetes, and self-identification as inner city American Indian. Participants were screened by telephone to ensure all criteria were met. Forty inner city American Indian men and women participated in 8 focus groups. PHENOMENON OF INTEREST: American Indians' perception of diabetes, its treatment, and how they manage the disease. ANALYSIS: Focus group discussions were tape recorded and transcribed verbatim. Transcripts were analyzed by coding responses and identifying common themes according to content analysis procedures. Quantitative data from self-administered demographic forms were analyzed. RESULTS: Participants could verbalize information regarding treatment and management of diabetes, but few could apply this information to their own lives. Some participants were homeless or without insurance, which makes successful disease management difficult. Perceptions of the health care system varied; a majority felt the system was meeting their needs, whereas others said it was not adequate. IMPLICATIONS FOR RESEARCH AND PRACTICE: The study identified the need for health care workers to develop a better understanding of how this population lives; doing so could improve patient compliance to treatment. The results may provide direction for the development of culturally specific diabetes education appropriate for low-income patients focusing on the diabetic diet and exercise, and suggesting ways that the patient can move from knowing the information to implementing behavior change. (Authors)