Understanding the Importance of Culturally Appropriate Patient-Provider Communication in PDF
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Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 Understanding the Importance of Culturally Appropriate Patient-Provider Communication in Diabetes Self-Management Anita Mwalui Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theAdult and Continuing Education Administration Commons,Adult and Continuing Education and Teaching Commons, and thePublic Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Anita Mwalui has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Frazier Beatty, Committee Chairperson, Public Health Faculty Dr. Magdeline Aagard, Committee Member, Public Health Faculty Dr. Kenneth Feldman, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract Understanding the Importance of Culturally Appropriate Patient-Provider Communication in Diabetes Self-Management by Anita Mwalui MPH, Walden University, 2012 BS, University of Baltimore, 2010 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2017 Abstract According to the Centers for Disease Control and Prevention, 29.1 million people in the United States have diabetes. Among those 29.1 million people, 21 million have been diagnosed, but 8.1 million have not. Changing demographics in the United States and the prevalence of diabetes are projected to be burdens on the health care system through 2050. Guided by the social cognitive theory, the purpose of this qualitative case study was to understand the importance of culturally appropriate patient-provider communication to the self-management of Type 2 diabetes by patients who are African immigrants. Culturally based health care has unique challenges when delivering culturally appropriate diabetes care, so a focus on cultural knowledge, intercultural patient-provider communication skills, and cultural assessment were key to this case study. One pilot study was conducted to test the focus group questions with 3 diabetes providers (i.e., certified nurse diabetes educator [CDE], registered nutritionist, and dietitian) who help patients to self-manage their diabetes. The second pilot study was conducted with 5 African immigrant patients who had been diagnosed with Type 2 diabetes. The primary focus groups were conducted with 5 CDEs and 10 patients. The transcribed responses were analyzed and categorized to identify the 17 themes that emerged (9 from the CDEs and 8 from the patients). One implication for social change is that a patient-centered approach to patient-provider communication will mean better health outcomes. To ensure culturally appropriate patient-provider communication, a change in health care delivery is required to incorporate cultural constructs as part of diabetes care and education to accommodate various ethnic and racial groups. Understanding the Importance of Culturally Appropriate Patient-Provider Communication in Diabetes Self-Management by Anita Mwalui MPH, Walden University, 2012 BS, University of Baltimore, 2010 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2017 Dedication I dedicate this work to my son, who was patient with me during his baseball games that I missed because I had papers and assignments to submit. My uncle, Rashid Nzito, was the role model who helped me to become the woman that I am today. He reminded me that “life can be growing pains, but looking ahead, there is always light at the end of the tunnel.” My best friend, Kent Clifford Mulholland, has loved me selflessly and has shown me the value of patience. My best friends, Joyce Lizwelicha and Dr. Adeola Akindana, helped me to understand the value of the window of opportunity: They told me that when the window opens, use the opportunity wisely, and the sky will become the limit. I thank Dr Idowu Abimbola, my spiritual adviser, who always knew when something was wrong just by the tone of my voice. I would like to thank Jewru Bandeh, my professional mentor, from whom I learned to appreciate the work that we do to empower the community we serve and how the community can build individuals. Acknowledgments Dr. Benjamin Beatty, Committee chair Dr. Magdeline Aagard, Committee member Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Chapter 1: Introduction to the Study ....................................................................................1 Background of the Study ...............................................................................................2 Problem Statement .........................................................................................................7 Purpose of the Study ....................................................................................................10 Significance of the Study .............................................................................................12 Research Questions ......................................................................................................13 Theoretical Framework: SCT ......................................................................................15 Definitions of Terms ....................................................................................................18 Assumptions .................................................................................................................20 Scope of the Study .......................................................................................................21 Delimitation .................................................................................................................22 Limitations ...................................................................................................................22 Summary and Transition ..............................................................................................23 Chapter 2: Literature Review .............................................................................................26 Introduction ..................................................................................................................26 Research Strategy.........................................................................................................27 Theoretical Framework: SCT ......................................................................................28 Significance of Patient-Provider Communication .......................................................33 Health Concepts of Cultural Knowledge, Sensitivity, and Competence .....................39 i Cultural Barriers to Care ..............................................................................................43 Immigrants’ Health Priorities ......................................................................................47 Social Change Through CEUs .....................................................................................49 Chapter 3: Research Method ..............................................................................................51 Introduction ..................................................................................................................51 Research Method .........................................................................................................52 Research Design and Approach ...................................................................................53 Target Populations ................................................................................................ 54 Sample Size ........................................................................................................... 56 Informed Consent and Confidentiality.........................................................................57 Data Collection ............................................................................................................58 Instrumentation ............................................................................................................60 Data Analysis ...............................................................................................................61 Threats to Internal and External Validity .....................................................................63 Summary ......................................................................................................................66 Chapter 4: Results ..............................................................................................................67 Introduction ..................................................................................................................67 Pilot Studies .................................................................................................................68 Pilot Study With CDEs ......................................................................................... 68 Pilot Study With Patients ...................................................................................... 75 Setting ..........................................................................................................................81 Demographics ..............................................................................................................81 ii Location .......................................................................................................................82 Data Collection ............................................................................................................83 Data Analysis ...............................................................................................................84 Results ..........................................................................................................................85 Results for CDEs................................................................................................... 85 Themes Generated From CDEs’ Responses ......................................................... 86 Results for Patients ............................................................................................. 105 Themes Generated From Patients’ Responses .................................................... 105 Summary ....................................................................................................................125 Chapter 5: Discussion, Conclusions, and Recommendations ..........................................126 Introduction ................................................................................................................126 Interpretation of Findings for CDEs ..........................................................................128 Discussion ..................................................................................................................128 Interpretation of Findings for Patients .......................................................................132 Discussion ..................................................................................................................132 Recommendation .......................................................................................................135 Implications................................................................................................................135 Conclusions ................................................................................................................136 References ........................................................................................................................137 iii
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