Adherence a Review: T2DM in Haitian-Americans

Friday, 28 July 2017

Balkys L. Bivins, PhD, ARNP, FNP-BC
School of Nursing, Barry University, Miami, FL, USA


The incidence and prevalence of diabetes mellitus (DM) has soared globally due to socioeconomic, demographic, and lifestyle changes, and lack of social justice. In the United States, DM has become a costly epidemic that resulted in an annual healthcare cost of $245 billion in 2012. The total prevalence of diabetes in the U.S. is significant at 29.1 million, of which 97.3 % is attributed to Type II diabetes (T2DM). Among the populations affected by the disease and the challenges to effective diabetes treatment and management are Haitian Americans in the U.S. The aim of this review from 1979 to the present on the concept of adherence in diabetes research is to summarize and synthesize recent studies, relevant theories, and models that examine the components of adherence in diabetes management within various populations of individuals diagnosed with T2DM. In addition, this presentation will examine the cultural components of adherence with T2DM in various immigrants in the U.S. This review will address the limited research findings specific to Haitian Americans.


On the issue of adherence research addressing T2DM in Haitian Americans, the review used the framework of Rodgers’ evolutionary process (2000). Its distinct components include: determining the concept to be studied, drafting a clear research question, defining the research process and gathering the pertinent information, synthesizing the research data and detailing specific conclusions, and research implications. Multiple searches were conducted using the terms “Haiti”, and “Haitians with diabetes”, yielding 18 articles on theories of cultural awareness in nursing. An in-depth review of the literature on adherence was generated from the year 1979 to the present with the following search engines: SocINDEX, PsycINFO, Medline, EBSCOhost, Eric, Cochrane, and CINAHL. Searching the term “adherence” resulted in 371,859 articles. Further restriction of the search scope to adherence and medication articles written in English resulted in 105,218 articles. Additionally, subcategorizing adherence and diabetes produced 4,578 articles. Search terms relating to adherence and diabetes management were added, revealing 846 articles. The investigation was further restricted by limiting the publication years to the period between 2010 and 2015 revealing 367 articles. Eventually, using keywords relevant to adherence to the treatment of diabetes uncovered 44 articles on adherence with diabetes. The studies reviewed by the researcher were chosen because they addressed adherence and its definitions, the components of Rodgers’ evolutionary process, culture, theoretical perspectives, and implications for nursing practice.


The analysis of research findings using Rodgers’ process (2000) identified the various factors for effective behavioral changes that impact adherence, diabetes management, and education in distinct and varied demographic groups. In addition, adherence to treatment of T2DM involves administration of medication, glucose monitoring, nutrition, and exercise. The researcher’s findings identified predominantly that adherence to treatment is a difficult process in managing T2DM. Although the review identified some factors as to why individuals do not adhere to treatment protocols, this difficult process remains elusive. Due to scarce literature on Haitian Americans, these studies, however, did not incorporate relevant theories that may explicate the dynamic, holistic, and culturally sensitive component necessary in the care of immigrant individuals, namely the Haitian Americans. Purnell’s model addresses this key cultural component directly but does not speak to the component of self-efficacy, a key factor in behavior modification. Therefore, nurses need to explore the complexity of T2DM management specific to the components of adherence, and how and why Haitian Americans face more challenges in managing T2DM.


Globalization, demographic influences, lifestyle changes, the complexities of life, and increased prevalence of chronic illnesses, specifically T2DM, pose a challenge in nursing. Even though adherence is a significant component with effective management of a variety of health conditions, the utilization of theories, behavioral modification, and cultural influences on behavior are often not considered an integral part of the treatment plans of individuals with T2DM. It is imperative that future nursing studies be directed to effectively develop holistic nursing interventions, nursing education, the use of eclectic theories, and the utilization of multidisciplinary resources. The previously stated interventions may aid in the improvement of health outcomes, social justice, and quality of life in these marginalized and vulnerable Haitian Americans. ­