Understanding the Importance of Culturally Appropriate Patient-Provider Communication in

160 Pages·2017·0.76 MB·English

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
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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