Date of Award

2017

Degree Name

PhD Nursing

Dissertation Committee

Susan L. Instone DNSc RN CPNP, Chairperson; Ann M. Mayo DNSc RN FAAN; Darlene McPherson PhD RN FNP-BC

Keywords

Decision-making, Diabetes Self-Management, Hispanic/Latinos, Mexican Immigrants, self-care, Type 2 Diabetes

Abstract

Purpose: This study explored how English-speaking Mexican-born immigrants with diabetes 2 (T2D) made decisions about diabetes self-management (DSM).

Background: Little is known about the self-care decisions of Mexican-born adults living in America with T2D. This information is needed so that health care professionals (HCPs) might better support patients’ DSM. T2D is a serious, multi-system disease, effecting persons of Mexican heritage almost twice as often as non-Hispanic whites (NHW); with lower insulin sensitivity, rapid prediabetes/T2D onset, and severe outcomes. Ineffectively managed blood glucose (BG) risks serious complications, reduced life quality, and premature death. T2D is primarily self-managed; requiring BG control. HCPs teaching Mexican émigrés encounter culturally-steeped beliefs that affect decision-making, contradict the science model and are not understood by NHW-HCPs.

Methodology/Results: A purposive sample of 12 (10 women/2 men) were recruited in Los Angeles County. Each participated in a 1.5 – 4-hour semi-structured interview conducted mostly in English. A bilingual research assistant/participant-observer clarified questions/interpreted Spanish explanations. Participants were queried about what influenced DSM decisions, self-care and cultural aspects. Constructivist grounded theory informed data analysis through constant comparison; results were confirmed by co-analysis.

Findings indicated that cultural requisites of being proper by practicing expected role/behavioral norms, eating hostess-prepared food, and hiding the socially-stigmatized diagnosis took precedence over positive DSM (+DSM). Food’s smell/taste, had emotive meaning. Presence at frequent socially-required events and desire to “enjoy today” were powerful decisioning forces that interfered with mastering DSM. To meet social requisites and enjoy flavors gave short-term pleasure but raised BG. The progressive nature of T2D was feared; none understood the progressive loss of insulin production. Motivation of love of family/fear of dreaded outcomes significantly impacted decisions. Accepting the T2D diagnosis/responsibility for/outcomes of DSM were key to being in the battle daily toward +DSM. All were Negotiating between short-term pleasure and illusive, long-term BG effects.

Implications: HCPs may help patients understand cultural influences that interfere with/promote +DSM, helping identify ways to negotiate short-term cultural requisites/avoid long-term outcomes may result in safer DSM decision-making. The substantive theory:

Negotiating every-day diabetes self-management decisions about conflicts between culture, personal enjoyment, and long-term outcomes toward mastery of type 2 diabetes by Mexican-born adults.

Document Type

Dissertation: Open Access

Department

Nursing

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