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Lived Experience of Tongans with Obesity and Diabetes Gladys Adjei-Poku Walden University

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Lived Experience of Tongans with Obesity and Diabetes Gladys Adjei-Poku Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Lived Experience of Tongans with Obesity and Diabetes Gladys Adjei-Poku Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Gladys Adjei-Poku has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Cynthia Fletcher, Committee Chairperson, Nursing Faculty Dr. Janice Long, Committee Member, Nursing Faculty Dr. Mattie Burton, University Reviewer, Nursing Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2019 Abstract Lived Experience of Tongans with Obesity and Diabetes by Gladys Adjei-Poku MSN, Western Governors University, 2014 BSN, New York University, 1992 BS, University of Ghana, 1981 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing Walden University August 2019 Abstract People of Pacific Island descent are afflicted by obesity and diabetes more than other populations. Although interventions have succeeded in reducing these conditions among other groups, they have been unsuccessful among Tongans and other Pacific Islanders. Furthermore, little is known about the cultural perspectives of this population with a high rate of obesity and diabetes. Accordingly, this descriptive phenomenological study was conducted to investigate the lived experiences of Tongans with obesity and diabetes in a western metropolitan area of the United States to understand their predisposition toward these conditions and suggest appropriate interventions. Purposive sampling was used to recruit 11 Tongans, 18 years or older, with obesity and diabetes. Face-to-face interviews were conducted using open-ended questions. Data analysis consisted of verbatim transcription and splitter coding, which identified 5 emerging themes. The findings indicated that cultural customs have created an emotional attachment among Tongan participants to their native foods and that they feel obliged to eat abundantly at food- related social events. Moreover, they mistrust their healthcare professionals, which results in nonadherence to medical advice. The findings align with Martha Rogers’ theory of the science of unitary human beings and Bandura’s model of reciprocal determinism that there is a strong relationship between people and their cultural environment. This study’s findings provide an understanding that may lead to positive social change in designing culturally specific preventive programs to decrease obesity and diabetes and ensure a better quality of life for Tongans. Lived Experience of Tongans With Obesity and Diabetes by Gladys Adjei-Poku MSN, Western Governors University, 2014 BSN, New York University, 1992 BS, University of Ghana, 1981 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing Walden University July 2019 Dedication I dedicate my dissertation to God in the name of Jesus Christ, who has been my strength as He has promised in Isaiah 41:10, “Fear not; for I am with thee: be not dismayed; for I am thy God: I will strengthen thee; yea, I will help thee; yea, I will uphold thee with the right hand of my righteousness.” To my husband, Michael, who supported me with prayers and encouragement and paid my full tuition at Walden out of pocket. To my son, Michael, and nephew Samuel Asante, who edited my work and encouraged me when I needed help. To my son, Yaw, and his family, who energized me when the going got tough and I was down. Acknowledgments Some exceptional individuals have contributed to the successful completion of my work. First, I would like to express my most profound appreciation to Dr. Cynthia Fletcher, who served as the chairperson of my dissertation committee. Her guidance, encouragement, unlimited patience, and the positive environment she created for me to do my work at Walden during my NURS 9000 quarters were invaluable, as was the outstanding and timely feedback she provided. Thank you very much, Dr. Fletcher. I would also like to express my heartfelt appreciation for the support I received from Dr. Janice Long. I am deeply grateful for your help, prompt responses, great insight, and the knowledge you shared. Thank you very much. Third, I would like to thank Dr. Mattie Burton, who served as my university research reviewer; your support is much appreciated. My sincere thanks also go to Dr. Leslie Hussey, who helped me refine my topic at a very early stage when my confusion was immense. Finally, I would like to acknowledge Mr. Matt L. Sharkey-Smith at the Writing Center, who patiently reviewed my papers over many quarters. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Background of the Study ...............................................................................................3 Problem Statement .........................................................................................................5 Purpose of the Study ......................................................................................................6 Research Questions ........................................................................................................7 Theoretical Foundation ..................................................................................................7 Nature of the Study ........................................................................................................9 Definition of Terms......................................................................................................10 Assumptions and Limitations ......................................................................................11 Scope and Delimitations ..............................................................................................12 Potential Transferability........................................................................................ 12 Limitations ...................................................................................................................13 Biases .................................................................................................................... 14 Significance of the Study .............................................................................................15 Summary and Transition ..............................................................................................16 Chapter 2: Literature Review .............................................................................................18 Introduction ..................................................................................................................18 Literature Search Strategy............................................................................................19 Theoretical Foundation ................................................................................................20 i Martha Rogers’s Model of Science of Unitary Human Beings ............................ 20 The Reciprocal Determinism Model ..................................................................... 22 Science of Unitary Human Beings, Reciprocal Determinism, and Tongans who have Obesity and Diabetes ................................................................ 23 Literature Review.........................................................................................................25 Pacific Islanders .................................................................................................... 25 Tongans ................................................................................................................. 30 Obesity .................................................................................................................. 34 Diabetes................................................................................................................. 39 Culture................................................................................................................... 40 Integrated Literature Review .......................................................................................42 Gaps in the Literature...................................................................................................44 Summary and Conclusions ..........................................................................................45 Chapter 3: Research Method ..............................................................................................49 Introduction ..................................................................................................................49
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