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Relational-Cultural Perspectives of African American Women with Diabetes and Maintaining Multiple Roles

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Relational-Cultural Perspectives of African American Women with Diabetes and Maintaining Multiple Roles University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations Dissertations and Theses November 2017 Relational-Cultural Perspectives of African American Women with Diabetes and Maintaining Multiple Roles Ayesha Ali University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_2 Part of the Other Nursing Commons Recommended Citation Ali, Ayesha, "Relational-Cultural Perspectives of African American Women with Diabetes and Maintaining Multiple Roles" (2017). Doctoral Dissertations. 1042. https://doi.org/10.7275/10586793.0 https://scholarworks.umass.edu/dissertations_2/1042 This Open Access Dissertation is brought to you for free and open access by the Dissertations and Theses at ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. Relational-Cultural Perspectives of African American Women with Diabetes and Maintaining Multiple Roles A Dissertation Presented by Ayesha Ali Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY September 2017 College of Nursing © Copyright by Ayesha Ali 2017 All Rights Reserved RELATIONAL-CULTURAL PERSPECTIVES OF AFRICAN AMERICAN WOMEN WITH DIABETES AND MAINTAINING MULTIPLE ROLES A Dissertation Presented By AYESHA ALI Approved as to style and content by: ________________________________________ Cynthia S. Jacelon, Chair ________________________________________ Genevieve E. Chandler, Member ________________________________________ Alexandrina Deschamps, Member ______________________________ Stephen Cavanagh, Dean College of Nursing DEDICATION This is dedicated to my mother and my always supportive husband. ACKNOWLEDGEMENTS I would like to give a heart-felt thanks to my advisor and chair of my dissertation committee, Cynthia Jacelon. She has provided unrelenting support, patience and kindness throughout this endeavor. Her guidance eased the complexity of the task before me at every stage. I would also like to extend my gratitude to the members of my committee, Genevieve Chandler, for her insightful comments and Alexandrina Deschamps for her cultural expertise. I want to thank the members of the Western Massachusetts Black Nurses Association for their ongoing support and encouragement and a special thanks to Raymond Jordan who facilitated getting participants for my study. I wish to express my appreciation to all the individuals who volunteered their participation in this project. Their wisdom, humor and trust in me to share their stories made the completion of this project possible. I want to give a special thank you to my children, Hassan, Quesiyah and Ibrahim, whose love and belief in my ability helped me to complete this project. And, an extra thank you to Ibrahim, whose technological skill, helped me beyond what I am able to express on this page. v ABSTRACT RELATIONAL-CULTURAL PERSPECTIVES OF AFRICAN AMERICAN WOMEN WITH DIABETES AND MAINTAINING MULTIPLE ROLES SEPTEMBER 2017 AYESHA ALI, B.S. UNIVERSITY OF MASSACHUSETTS AMHERST M.S. UNIVERSITY OF MASSACHUSETTS AMHERST Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Cynthia S. Jacelon The growth of diabetes in the United States is viewed by some as epidemic with a particular concern as related to African American women. African American women experience diabetes disproportionately to other groups with higher risks of complications and premature death. Historically, they have led all women in labor force participation and maintained roles within and outside the home. The purpose of this study was to gain understanding and meaning of the lived experience of African American women with diabetes and maintaining multiple roles using sensitizing concepts of Relational-Cultural theory. Relational-Cultural theory was described as related to use with women and the incorporation of the influence of culture. The literature review used proxy terms for the concepts of connection, disconnection, mutuality and power over related to limited use of theory concepts in the literature. The review yielded few research studies. Interpretive phenomenology following Ricoeur in philosophy and methodology was used. Three composites of the day-to-day experiences of African American women with diabetes and maintaining multiple roles were provided. The concept of connections diverged into two types of connections with multiple themes. Mutuality themes were not a matter of age but vi what each brings to the other and closeness developed over time. Themes that emerged related to concepts of disconnections and power over were the will to keep negativity out, disappointment in others, shackles on, shackles off, financial stress makes life difficult. Themes of informational support in the neighborhoods, trust is necessary and need for African American nurses related to the role of nurses with enhancing connections and mutuality. Further nursing research is needed related to use of Relational-Cultural theory and African American women with diabetes and maintaining multiple roles to increase a contextual understanding of their lived experience. Incorporation of Relational-Cultural theory into practice and nursing education was also suggested based on two decades of neuroscience evidence about the importance of relationships. vii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS .................................................................................................v ABSTRACT ....................................................................................................................... vi LIST OF TABLES ............................................................................................................ xii CHAPTER 1. INTRODUCTION ...................................................................................................1 Purpose ...............................................................................................................3 Rational for Research Approach ........................................................................3 Research Questions ............................................................................................4 Definitions Relevant to the Study ......................................................................5 Conceptual Framework ......................................................................................7 Methodology Overview .....................................................................................9 Summary and Significance of Inquiry of Phenomenon to Nursing .................10 2. REVIEW OF LITERATURE ................................................................................12 Connections of African American Women with Diabetes ..............................13 Connections of African American Women Maintaining Multiple Roles ........15 Disconnections of African American Women with Diabetes ..........................16 Disconnections of African American Women with Multiple Roles ................20 Mutuality of African American Women with Diabetes ...................................24 Mutuality of African American Women with Multiple Roles .........................26 Power Over of African American Women with Diabetes ...............................27 Power Over of African American Women Maintaining Multiple Roles ........ 28 Chapter Summary ............................................................................................32 Discussion of Chapter Sections .......................................................................33 Key Points Warranting This Study ..................................................................38 3. METHODOLOGY ................................................................................................40 Phenomenology Research ................................................................................40 Philosophical Foundation of the Research Design ..........................................40 Participant Selection and Sample.....................................................................42 Gaining Access and Entering the Setting.........................................................43 viii Protection of Participants and Ethical Considerations .....................................45 Data Generation and Treatment .......................................................................46 Data Analysis and Management ......................................................................48 Data Collector’s Credentials and Training ......................................................49 Trustworthiness ................................................................................................49 Credibility ..............................................................................................50 Transferability .......................................................................................51 Confirmability and Dependability ........................................................51 Summary ..........................................................................................................52 4. FINDINGS .............................................................................................................55 Section 1: The Day to Day Lived Experience of African American Women with Diabetes and Maintaining Multiple Roles ..............................................60
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