Health-care seeking behaviors of Puerto Ricans with diabetes mellitus who live in South Florida: An exploratory study
Laura N. Gonzalez, PhD, APRN, CNE, CHSE-A, ANEF, FAAN
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Latinos are the fastest growing minority population in the United States (U.S.) and have the worst access to health care of any ethnic group. The chronic disease of diabetes is twice as common in adult Latinos as in non-Latino whites, and the risk of death related to diabetes is twofold. Reasons for this disparity have yet to be clearly identified. This study had two purposes: 1) to explore cultural beliefs regarding health-care seeking behaviors in Puerto Ricans with diabetes who live in South Florida; and 2) to examine Puerto Ricans’ perceptions about their health-care providers. The cultural phenomena of interest were familism, religiosity, spirituality, use of ethnomedicine, and perception of ethnic concordance of health-care provider. Numerous studies have examined these phenomena with other Latino groups, but none have specifically focused on Puerto Ricans. An overarching goal of the study was to contribute to the knowledge base on a particular health disparity—diabetes.
Using a narrative inquiry approach, a purposive sample of self-identified Puerto Ricans with diabetes (N = 12) were recruited from six sites in a South Florida city. Data were obtained using a pencil-and-paper demographic instrument, the Short Acculturation Scale to determine language preference of Spanish or English, and a personal interview using a semi-structured, ten-item interview guide. Subjects gave written informed consent for participation, and all data were coded to ensure confidentiality. The personal interviews were tape recorded and transcribed verbatim. Interviews completed in Spanish were translated to English and transcribed. Using content analyses techniques, transcribed narratives were analyzed for content and thematic emergence.
The findings revealed that familism was an important consideration in health-care seeking behaviors. Traditional gender role expectations, coupled with caregiver burdens, deterred some participants from seeking care even when care was needed. Religiosity and spirituality did not influence decision-making but did have a role in coping with the chronic disease. While participants were aware of culturally based ethnomedicine, they preferred Western medicine for the treatment of their diabetes. They also had a preference for a health-care provider who was ethnically concordant. Serendipitous findings that emerged in the analyses included the casual attitude of several participants about their diabetic status and reports of depressive-like symptoms among most of the women. Health-care providers need to take into consideration the cultural and linguistic preferences of Puerto Ricans to develop an appropriate and effective treatment plan. Discrepancies between the health-care providers and the clients’ systems must be reconciled to improve adherence to evidence-based treatment.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3377816; ProQuest document ID: 304379869. The author still retains copyright.
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