Date of Award

2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Barbara Riegel

Abstract

Self-care is vital in chronic illness management. Self-care entails three core processes: self-care maintenance (e.g., following dietary recommendations), self-care monitoring (e.g., monitoring blood glucose), and self-care management (e.g., calling a provider for symptoms). Persons who engage effectively in self-care have improved perceived control over their illness, better quality of life, lower hospitalization, and less mortality compared to those with poor self-care. Multiple factors are known to influence self-care, but less is known about how sociocultural factors influence self-care among African immigrants living with chronic illness. To date, much of the self-care research has grouped all persons of African-descent into one “Black/African-American” category. This limits our ability to understand the sociocultural variations among Black/African American subgroups that may influence self-care and impairs progress in developing targeted interventions that may improve the lives of Black people with chronic illness. To address this gap, this dissertation aimed to: (1) synthesize the existing evidence of the cultural factors that influence self-care in persons with cardiovascular disease through an integrative review (Chapter 2); (2) identify the cultural factors that influence self-care practices among African immigrants living with chronic illness in countries outside Africa using mixed studies review (chapter 3); and (3) describe the self-care behaviors of adult African immigrants in the U.S. living with a chronic illness. In a cross-sectional study, we assessed the relationship between acculturation and self-care and explored potential determinants of self-care using general linear modeling (chapter 4). Cultural beliefs and norms challenge adherence to recommended diets and medication regimens in persons with cardiovascular diseases (Chapter 2). Cultural identity was both a driver and a constraint to engaging in self-care in African immigrants with chronic illness. Further, structural factors such as unemployment, lack of insurance, high cost of healthcare, and immigrant status-related discrimination, linguistic challenges, and ineffective physician-patient communication also influenced self-care (Chapter 3). Overall, the self-care of African immigrants across the three domains of self-care maintenance, monitoring, and management was adequate. Specific self-care behaviors found to be low in this population include eating a special diet, and monitoring for medication side-effects, and fatigue. Acculturation was not associated with self-care. Self-care self-efficacy was a strong determinant of self-care. The perception of inadequate income was another significant determinant of poor self-care management (chapter 4). Taken together, these findings demonstrate that cultural and structural factors that influence individual self-care behaviors need to be accounted for in order to promote self-care behaviors in African immigrants living with chronic illness.

Included in

Nursing Commons

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