Cultural Influences and Haitian American Women With Type 2 Diabetes in America

Background: The global burden of diabetes is estimated at approximately 422 million diagnosed cases (World Health Organization [WHO], 2017). As of 2015, more than 30.3 million individuals in the United States have diabetes (Centers for Disease Control and Prevention [CDC], 2017). Appallingly, about 90%-95% of these cases are attributed to potentially preventable type 2 diabetes mellitus (CDC, 2018). The significant incidence and prevalence of type 2 diabetes mellitus are a public health concern and a growing financial crisis in the U.S. In 2015, the American Diabetes Association (ADA) estimated 79,535 deaths directly due to diabetes and 252,806 deaths with complications of diabetes as a contributing factor (ADA, 2018). There are disparities among African Americans and Caribbean Americans as compared to their White counterparts specific to the incidence, prevalence and health outcomes of type 2 diabetes mellitus (ADA, 2016; CDC, 2014; Gucciardi et al., 2013). Among Caribbean Americans, Haitian American women comprise an especially vulnerable population that has difficulty with the treatment and management of type 2 diabetes mellitus resulting in health complications. These complications may include amputations, retinopathy, neuropathy, nephropathy, coronary artery, and cerebral vascular events (CDC, 2016). Most studies discuss adherence to treatment and management as the main factor in the care of individuals with type 2 diabetes mellitus (Huffman, Exebio, Vaccaro, Zarini, & Dixon, 2013; Vimalananda et al., 2011). As there were no prior studies on the lived experience of HAW with type 2 diabetes mellitus in the literature, a phenomenological study was necessary to understand and highlight the importance that cultural factors play in the care of Haitian American women with type 2 diabetes mellitus. The study revealed that nurses must integrate cultural factors into the treatment and management plan for Haitian American women with type 2 diabetes mellitus to decrease complications, improve health outcomes, and enhance the quality of life of these individuals.

Purpose: The purpose of this paper is to report on the cultural factors that influence adherence in Haitian American women with T2DM living in South Florida.

Philosophical Underpinning: This qualitative study was conducted through the philosophical lens of interpretivism. Further, use of van Manen’s hermeneutic phenomenology allowed the researcher to understand how culture influences the lives of HAW with type 2 diabetes mellitus living in South Florida.

Methods: A qualitative approach using van Manen’s six research activities guided this research study. Purposive and snowball sampling techniques were used to recruit 25 participants until data saturation was reached. A vignette was used to initiate conversation with semi-structured, open-ended questions. Data collection was conducted in English or Haitian Creole, using face-to-face individual interviews that were digitally audio-recorded and transcribed. Data were analyzed using Creswell’s (2013) nine steps of data analysis, which provided a comprehension and systematic approach to review the data (transcripts).

Results: A predominant theme that evolved from this study was the shifting cultural norms and its related subtheme of dietary restriction. Shifting cultural norms relates to how individuals change their lifestyle in response to living with type 2 diabetes mellitus in a new country (Bivins, 2018). In this study, Haitian American women with type 2 diabetes mellitus living in the United States experienced difficulty shifting cultural norms, especially as it related to modifying their diet according to recommendations made for the management of their type 2 diabetes mellitus.

Conclusions: This study highlighted how cultural norms influence the lives of Haitian American women with type 2 diabetes mellitus. The shifting cultural norms and dietary restrictions were challenging for the Haitian American women with type 2 diabetes mellitus in this study. The participants expressed their difficulty with changing their dietary habits necessary to treat and manage their disease due to their cultural norms.

Recommendations for Future Research: The literature review did not find any previous studies exploring the lived experience of Haitian American women with type 2 diabetes mellitus. Therefore, a qualitative study using van Manen’s phenomenology was the best way to understand how Haitian American women with type 2 diabetes mellitus address manage this disease. New qualitative and quantitative research is needed in this population. Appropriate future research is essential to examine how culture affects the health outcomes of Haitian American women with type 2 diabetes mellitus.