Self-management by uninsured Filipino immigrants with Type 2 Diabetes

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dc.contributor.advisorInouye, Jillian
dc.contributor.authorLeake, Anne Reynolds
dc.contributor.departmentNursing
dc.date.accessioned2009-03-06T19:21:39Z
dc.date.available2009-03-06T19:21:39Z
dc.date.graduated2003-12
dc.date.issued2003-12
dc.descriptionvii, 274 leaves
dc.description.abstractFilipino Americans have a higher prevalence of type 2 diabetes than the national average. Good self-management (SM) of diabetes is required for good outcomes. Uninsured Filipino immigrants face cultural and financial barriers to good outcomes. The purpose of this study was to describe self-management by uninsured Filipino immigrants with type 2 diabetes. Results from the study will reduce the risks of complications by improving self-management education. Qualitative research on diabetes self-management [SM] and research on Filipinos and health were reviewed. Concept analysis of SM using the Wilsonian method (Wilson, 1963) produced eight essential elements. An applied ethnography was conducted with 11 participant interviews and 100 hours of field observation over 10 months. Participants were two men and nine women, ages 57 to 74, attending a free diabetes clinic in federally funded community health center in urban Hawaiʻi. The explanatory model [EM] (Kleimnan, 1980) and a model for health disparities (Cooper, 2002), guided the study. Purposive sampling achieved a range of participants across factors of age, recent HgbA1c, years with diabetes, and years in Hawaiʻi. An inquiry audit by an external expert was done. Significant statements coded into four domains of barriers, the explanatory model, family and self-management behavior. Participants' EMs combined Western and naturalistic explanations, including avoiding a hot climate and use of local plants (bittermelon and noni) recommended by other Filipinos. All participants exercised and most used SM strategies of control and moderation. Four cultural themes were induced from the data: 1.) rice is more than just a starch; 2.) worry is a Filipino pastime; 3.) advice is a gift freely given and received; and 4.) the family is everything. Participants demonstrated five of the essential elements of SM but did not do as well with consulting health care team, problem solving and increasing self-efficacy. The family's group efficacy, as much as self-efficacy, influenced behavior change. Participants' SM compared favorably to other populations for behavioral change, emotional distress and support from family and friends. Implications for clinical practice were emphasis on group efficacy and reducing barriers to medical consultation. Further research to explore the concept of worry was recommended.
dc.identifier.urihttp://hdl.handle.net/10125/6898
dc.publisherUniversity of Hawaii at Manoa
dc.relationTheses for the degree of Doctor of Philosophy (University of Hawaii at Manoa). Nursing; no. 4400
dc.rightsAll UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
dc.rights.urihttps://scholarspace.manoa.hawaii.edu/handle/10125/2116
dc.titleSelf-management by uninsured Filipino immigrants with Type 2 Diabetes
dc.typeThesis
dc.type.dcmiText
local.identifier.callnumberAC1 .H3 no. 4400
local.thesis.degreelevelPhD

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