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Use of Complementary Therapies for Diabetes Mellitus By USE OF COMPLEMENTARY THERAPIES FOR DIABETES MELLITUS BY JAMAICAN ADULTS IN SOUTH FLORIDA: A FOCUSED ETHNOGRAPHY by Raquel A. Brown A Dissertation Submitted to the Faculty of Christine E. Lynn College of Nursing In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Florida Atlantic University Boca Raton, FL August 2019 Copyright 2019 by Raquel A. Brown ii ACKNOWLEDGEMENTS “It takes a village” (Anonymous). I am a product of this village and so it is no easy feat to thank everyone who has guided me to this pinnacle in my life. First, I thank God for giving me the grace to make it to this point. Thank you to all my family, friends, colleagues, and my dissertation committee who nurtured me, influenced me and guided my path. I could not have completed this dissertation without the participants whose knowledge was poured out in this paper. The financial assistance I received helped to ease my journey. To Dr. Lenny Chiang-Hanisko, the Chair of my dissertation committee, thank you for the tireless hours you put into working with me. Thank you Dr. Lenny Chiang- Hanisko, Dr. Marlaine Smith, and Dr. Susan Love Brown for letting me lean on your expertise. I thank the faculty and staff and my colleagues at the Christine E. Lynn College of Nursing, Florida Atlantic University for the input and critique that helped me hone my research question. I am grateful for the financial assistance I received from the following organizations: Gertrude E. Skelly Foundation Stipend; Cross-Country Scholarship; Jonas Nurse Leader Scholarship; Florida Nurses Foundation Scholarship; and the Florida State Doctoral Stipend. iv Special thanks to my siblings, especially my big sister Avis Brown who took care of me at the passing of my mom. Thanks also to Myrtle Thompson who helped me on my beginning journey to nursing school. I am eternally grateful to the village that raised me. ii ABSTRACT Author: Raquel A. Brown Title: Use of Complementary Therapies for Diabetes by Jamaican Adults in South Florida: A Focused Ethnography Institution: Florida Atlantic University Dissertation Advisor: Dr. Lenny Chiang-Hanisko Degree: Doctor of Philosophy Year: 2019 Jamaicans, the largest group of English-speaking Caribbean people living in the United States (US), have a history of using bush medicine/complementary therapies (CT) in diabetes management. However, no research described the emic views of Jamaican adults regarding how they select the bush medicine they use or how they know these are suitable to manage diabetes. The purpose of this focused ethnography was to explore and describe how Jamaican adults with diabetes mellitus who live in South Florida select and use complementary therapies for managing their diabetes. The objectives were to: (1) Explore the emic views of Jamaican adults about using CT to manage diabetes mellitus; (2) Describe the rationale given by Jamaicans adults for using CT to manage diabetes mellitus; (3) Analyze and synthesize the data gathered about use of CT for diabetes by Jamaican adults to see if their actions have cultural components that can serve as a basis for providing culturally competent care. iii There were 13 informants, 7 males and 6 females. There were eight key informants who fully met the inclusion criteria, and five general informants who had knowledge of bush medicine and contributed rich data to the study. Key informants were adults with self-reported diagnosis of diabetes mellitus who emigrated from Jamaica and/or their second-generation offspring who live in South Florida; Jamaican adults who used at least one complementary therapy in managing diabetes mellitus for at least one year. The informants ages ranged from 44-74 years, with a mean age of 59 years. The average years in the US was 25 years. Informants reported having diabetes for as few as 5 years and as many as 31 years. The focused ethnography entailed in-depth interviews and persistent observation. An inductive qualitative content analysis was employed. Five major themes emerged from the data: (1) Jamaicans follow individualized and diverse folk care patterns when using CT; (2) Jamaicans believe CT are affordable folk care promoted by people they can trust; (3) Jamaicans use traditional folk remedies for managing diabetes; (4) Jamaicans are willing to try folk care in the face of uncertainty; and (5) Jamaicans use self-management strategies trusting the wisdom of the elderly. Leininger’s Sunrise Enabler to Discover Culture Care was applied during the interpretation of the themes. Results indicate that the Jamaicans who participated in this study value sharing as a community and practice self-management according to cultural tradition. Study findings can be used to guide safe cultural care of Jamaican adults with diabetes who use bush medicine to manage their diabetes by aiding healthcare providers in planning ii education, creating and implementing related policies, designing future research and applying appropriate practice approaches. It is recommended that future research be conducted in a similar population using community based participatory research. The study population will be partners in the research process and will likely feel more appreciated as they make contributions and recommendations about how to meet their cultural needs. iii DEDICATION I dedicate this dissertation to the memory of my late mom Una Priscilla Lawson. My mom instilled in me the value of books and the importance of reading at an early age. She was my first teacher in many things including valuing respect for self and others and maintaining relationships with others. I think she had a wealth of knowledge beyond my understanding. Bush medicine was a part of our lives that I did not perceive until recently, and might, along with my professional experience, have influenced my interest in the subject. Rest forever in peace. I love you mom. USE OF COMPLEMENTARY THERAPIES FOR DIABETES MELLITUS BY JAMAICAN ADULTS IN SOUTH FLORIDA: A FOCUSED ETHNOGRAPHY LIST OF TABLES ................................................................................................................... ix LIST OF FIGURES .................................................................................................................. x CHAPTER I. INTRODUCTION .............................................................................................. 1 Phenomenon of Interest ......................................................................................................... 1 Purpose .................................................................................................................................. 3 Research Questions ............................................................................................................... 3 Significance ........................................................................................................................... 3 Background ........................................................................................................................... 4 Connection to Caring Science ............................................................................................... 9 Researcher’s Perspective ..................................................................................................... 13 Experiential ...................................................................................................................... 13 Theoretical ....................................................................................................................... 14 Conceptual Definition of Terms .......................................................................................... 15 Summary ............................................................................................................................. 16 CHAPTER II. LITERATURE REVIEW ............................................................................... 18 Historical Roots ................................................................................................................... 20 Use of Herbal Remedies and Food for Self-care for Diabetes ............................................ 21 Religion and Spirituality as CT for Self-care for DM ......................................................... 26 v The Humoral System as CT for Self-care for DM .............................................................. 29 Other CT Used in Diabetes Care within the Caribbean ...................................................... 30 Critical Synthesis of Theoretical and Empirical Foundation .............................................. 31 Common Practices ........................................................................................................... 32 Infrequent Practices ......................................................................................................... 34 Discussion of gap in knowledge base. ................................................................................ 35 Summary ............................................................................................................................. 37 CHAPTER III. RESEARCH METHODOLOGY .................................................................. 38 Research Design .............................................................................................................. 39 Procedure ......................................................................................................................... 42 Sampling, Recruitment, Setting
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