The Factors Affecting the Management of Diabetes Among Haitian Elders, Research Paper Example

The review of the literature seeks to illuminate salient patterns in the management of health among diabetic patients from minority and immigrant populations, in order to speak to the present work. The selected works address self-management of diabetes, seeking to illuminate not only behavior, but also the underlying reasons for behavior. This is essential that the mission of the study to cast light upon self-care practices of Haitian-American diabetic patients, and the reasons for them, might be fulfilled, in keeping with the importance accorded to these under Leininger’s Theory of Nursing.

Garcia (2008) evaluated the association between choice of clinic and two diabetes indicators among Mexican-American patients recruited from a hospital-associated clinic and a free clinic, respectively. The participants were overwhelmingly women of low socioeconomic status, with a mean age of 53 years (p. 152). The two indicators in question were levels of A1c, or glycosylated hemoglobin, and perceived quality of life (p. 150). A1c is the main metric used to evaluate physiological management of diabetes, with higher levels corresponding to worse symptoms. Quality of life is also an important metric for diabetes status, because diabetes has a tendency to significantly erode quality of life (p. 150).

Garcia (2008) found that the patients at the free clinic had significantly higher A1c than those at the hospital-affiliated clinic (p. 153). Clinic selection was also correlated with quality of life, as patients at the free clinic had on average a slightly lower quality of life (p. 153). This is in keeping with the fact that free clinics tend to serve impoverished, marginalized populations, and these populations generally suffer from lower quality of life, less knowledge, etc. (pp. 150-153). While both clinics served impoverished, marginalized populations, at the free clinic there were more patients who tended to be less acculturated, with lower levels of education, more recent diagnoses of diabetes and fewer medications (p. 155).

Self-management of diabetes symptoms in minority populations of low socioeconomic status is of considerable interest, particularly because these populations are more vulnerable. Minority adults tend to contract diabetes at a significantly higher rate than their white counterparts. In a study of white, African-American, Hispanic and Asian patients, Yeboah-Korang, Kleppinger, &Fortinsky (2011) found that both African-Americans and European-Americans were more likely than the others to be obese, and both Hispanics and whites more likely to have depression and open wounds (p. 1125). Asian-Americans had the greatest levels of physical disability (p. 1125). Both Hispanics and African-Americans were underserved populations with regard to physical therapy services and home health aides (p. 1125).

Lynch, Fernandez, Lighthouse, Mendenhall and Jacobs (2012) studied self-management of diabetes in a sample of African-American and Mexican-American populations, and found that among both populations the most commonly used strategies were pharmacotherapy, eating a healthful diet and exercise (pp. 817-818). Among dietary strategies, greater consumption of fruits and vegetables and managing portion size were the most common strategies for controlling diabetes.

There were also key differences between the populations. A case in point is that among African-American participants some expressed skepticism about taking medications, a theme not seen with the Mexican-American participants (Lynch et al., 2012, p. 818). Issues raised by Mexican-American patients included getting access to medications. Patients in this group were also more likely to use herbal remedies, notably cactus (nopal) and aloe vera (sabila). The groups also differed in terms of their practices of exercise. Where Mexican-Americans favored the use of intentional exercise of long duration as a means of managing their condition, African-Americans were more likely to see exercise as something they did in the course of daily activities (pp. 817-820). Both groups talked about weight loss, noting that doctors had told them that if they lost some weight they would see improvements in their condition (p. 819).

Gill, Kumar, and Wiskin (2008) studied diabetes self-management knowledge (DSK) in an ethnically mixed sample of 300 patients from a district general hospital in Birmingham in the UK. They found that roughly equal percentages of patients had “poor” DSK (35%) and “good” DKS (34%). They found a similar pattern for those with “very poor” DSK (15%) and “very good” DSK (17%) (p. 101). Ethnic minorities had lower DSK than their white counterparts; in particular, 100% of Black Africans (n=4) had “very poor” DSK (p. 102). Whites, on the other hand, had the highest levels of “good” and “very good” DSK (pp. 102-103). The reasons for this disparity remained unclear, though possible confounding factors include issues with language barriers, different attitudes about health and other variables (p. 104). A total of 121 patients attended an education session; of these, 40% said it was useful, 40% declined to respond and 6% said it was not useful (p. 103).

Family experience of diabetes has been shown to correlate with greater awareness of risk factors and better health management to avoid these risk factors among African-Americans (Baptiste-Roberts, Gary, Beckles, Gregg, Owens, Porterfield, & Engelgau, 2007, p. 907). Baptiste-Roberts et al. surveyed some 1,122 African-American adults who did not have diabetes, and found that those who had family members who were diabetic were more aware of a number of risk factors for diabetes, particularly having a family member who has diabetes (pp. 907-909). Other risk factors of which they were more likely to be aware included being overweight, not exercising, and consuming foods that are dense in energy (pp. 907-909). Another marked difference is that these individuals were more likely to consume at least 5 servings of fruits and vegetables every day, and to have undergone screening for diabetes (pp. 907-909).

Noting that there is some evidence of poorer diabetes management outcomes among African-Caribbean populations, Brown, Avis, and Hubbard (2007) surveyed 16 African-Caribbean people from inner-city Nottingham (p. 461). The goal was to gain deep insight into beliefs and knowledge about diabetes management among these populations. Participants spoke fondly of childhoods in the West Indies, and expressed the belief that the diet they had followed there was “natural” and “fresh” and thus healthy, although it was very high in sugar and starches (p. 463). In particular, they believed that the hot climate of those lands helped them to burn off calories, particularly because physical exercise was such an important part of everyday life. Herbal remedies were the medications they reported using most commonly in their homelands (p. 463).

As for the onset of their diabetes, some participants said that they thought that the migration from the West Indies to the UK was a key factor (Brown et al., 2007, p. 464). Between the climate, the culture, experiences with racism and adjusting to new ways of life, many individuals felt that their health had been compromised in ways that made them more vulnerable to diabetes (p. 464). They also cited the switch to a more British diet, particularly fast food, bread, and milk (p. 464). Most of those interviewed had at least a basic knowledge of diabetes, and some had a very good understanding. A number of them reported medically unsubstantiated beliefs, and some were mistrustful of “chemicals” and injections (pp. 464-465). An important limiting factor in many cases appeared to be stress, with many participants reporting that it was a significant demotivating influence (p. 463). A number of participants also cited concerns that the National Health Service (NHS) did not care for them adequately because of their race (p. 467).

Smith (2011) evaluated cultural beliefs of Afro-Caribbean women in order to ascertain their impact on diabetes management. Smith found that all participants surveyed shared the same beliefs about diabetes management, including beliefs about the efficacy of traditional medicine, the need to modify the traditional Caribbean diet to better manage diabetes, and strong religious faith in the power of prayer (pp. 643-644). Participants referred to a number of traditional herbs as medicinal, particularly Momordicacharantia(p. 644). They saw these herbs as complementary to prescribed medications, but also expressed the idea that they could use them to wean themselves off prescribed medications. Participants did understand that the high-starch, -sugar, and –fat diet of the Caribbean was ill-suited to managing diabetes (p. 644). They also saw praying to God as an important and necessary part of managing their diabetes (p. 644).

Sullivan, Hicks, Salazar, & Robinson (2009) found that among a sample of 35 Latino patients with type 2 diabetes, perceived self-control of diabetes and satisfaction with treatment was very high (p. 387). However, many of the treatments were home remedies, including herbal medicines and the use of such things as coffee, garlic pills, lemon juice mixed with crushed egg shells, and others (p. 387). Only one individual (3% of the total) reported that they had made any changes to their diet at all (p. 387). This demonstrates a great need for better education and outreach to diabetic patients from low-income minority populations.

It is clear that diabetes management is possible if patients have the right knowledge and understanding (Weiler & Tirrell, 2007). However, low-income populations, particularly low-income minority populations, are underserved in this regard (p. 21). Weiler and Tirrell evaluated an in-house diabetes education program that achieved significant results in helping low-income Latino patients achieve improvements to glycemic control (p. 21). The key was proper training of nurse educators. Once this had been done, the nurse educators evinced full mastery of the curriculum and were fully ready to teach patients (p. 23). In particular, nurse educators reviewed patients’ charts, made use of a number of appropriate teaching materials, and demonstrated good interpersonal skills (p. 23).

A study of a similar effort involving 22 physicians who worked in three different family medicine clinics found support for the use of additional personnel support, specifically part-time collaborative care therapists who served as outreach health coaches (Sieber, Newsome, & Lillie, 2012, p. 322). Outreach health coaches who partnered with physicians helped to improve clinical outcomes in patients. In particular, thanks to the involvement of outreach health coaches, more diabetic patients were more engaged with managing their condition (p. 326). They were more likely to watch instructional videos about how to manage their condition, and they were more likely to schedule and complete a visit with their physician (p. 326). This establishes that even a little bit of education can make a significant difference to patients’ self-efficacy.

The review of the literature establishes the importance of taking into account the underlying beliefs of patients in ascertaining how they manage their condition, and how interventions might well be improved. Culturally sensitive outreach attempts, in particular, have much to commend them as efficacious strategies for promoting better diabetes management among underserved minority and immigrant populations. Of foundational importance, the findings here discussed reveal some of the salient dimensions of diabetes management knowledge among these populations, including self-care strategies and predictors for a fuller understanding.