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Cultural and Family Challenges in Type Two Diabetes Self-care for Puerto Rican Identified Hispanic Adults

ABSTRACT CULTURAL CHALLENGES IN TYPE TWO DIABETES SELF-CARE FOR PUERTO RICAN IDENTIFIED HISPANIC ADULTS FEBRUARY 2019 JALIL A. JOHNSON, B.S.N., MIDDLE TENNESSEE STATE UNIVERSITY M.S., UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL, WORCESTER Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Dean Stephen Cavanagh Background: Puerto Rican identified Hispanics are disproportionately affected by type 2 diabetes and co-morbid conditions compared to their white counterparts. Culturally tailored interventions improve self-care for Hispanic populations. Interventions should be tailored to the targeted Hispanic subgroup. The intersection of Familism in Puerto Rican culture as it influences type 2 diabetes self-care is not well understood. Research Aims: The primary aim of this study was to define specific socio-cultural phenomena, Familism as a facilitator or inhibitor of diabetes self-care for Puerto Rican identified Hispanics living in the continental U.S. A secondary aim was to examine how health care professionals may best include the PRiH family in care planning. Methodology: A qualitative methodology, specifically Case method with an instrumental approach was used. To assess Familism, pre-established definitions of Familism were compared with the lived experiences of the (n=25) subjects in the study. Four primary sources of data collection were used and included focus groups (n=12 patient subjects), semi structured interviews (n=5 healthcare provider subjects), semi structured interviews (n=5 community member subjects), field notes, and participant observation. Member and nonmember checking (n=3 subjects) was used to confirm the study findings; as well as other validity constructs to ensure credibility, transferability, dependability and conformability. Data analyses was primarily thematic. NVivo software was used to facilitate exploration of the data for themes. Outcomes: Outcomes of this study were primarily descriptive and provide a greater understanding of the social dynamics affecting diabetes self-care for Puerto Rican identified Hispanics living in the continental U.S. Significant findings from this study include clarification of the substantial impact of Familism dynamics on diabetes self-care for PRiH men and women; and the experiential differences between men and women. Importantly, this data is important for researchers designing culturally tailored studies targeting Puerto Rican identified Hispanic adults.