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Abstract

Introduction:

Bhutanese refugees have a higher prevalence of type 2 diabetes but are less likely to achieve medication adherence and glycemic control. The purpose of this project was to understand factors affecting diabetes medication adherence in this population.

Methodology:

This was a qualitative project using focus groups of adult Bhutanese refugees with type 2 diabetes ≥18 years old and hemoglobin A1C ≥8% and their caregivers from a family medicine clinic at the University of Kansas. Data were analyzed using content analysis.

Results:

A total of 23 individuals participated. Three themes emerged from data analysis: desire to engage in care but face multiple barriers, family and community support invaluable for health, and considerations for culturally contextual person-centered care. Participants provided specific recommendations to address the barriers, with emphasis on improving health literacy.

Discussion:

Integrating the identified factors can foster person-centered, culturally congruent care to improve diabetes medication adherence in Bhutanese refugees.

Keywords

diabetes medication adherence refugees Bhutanese Nepalese language

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References

Betancourt

T. S.

Frounfelker

Mishra

Hussein

Falzarano

. (2015). Addressing health disparities in the mental health of refugee children and adolescents through community-based participatory research: A study in 2 communities. American Journal of Public Health, 105(Suppl. 3), S475–S482. https://doi.org/10.2105/ajph.2014.302504

Bethel

M. A

Patel

R. A

Merrill

Lokhnygina

Buse

Mentz

R. J.

Pagidipati

N. J.

Chan

J. C.

Gustavson

S.M.

Iqbal

Maggioni

A. P.

Ohman

Poulter

N. R.

Ramachandran

Zinman

Hernandez

A. F.

Holman

R. R.

(2018). Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: A meta-analysis. The Lancet Diabetes & Endocrinology, 6(2), 105–113. https://doi.org/10.1016/s2213-8587(17)30412-6

Brown

M. T.

Bussell

J. K.

(2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.2010.0575

The Centers for Disease Control and Prevention. (2020). National diabetes statistics report: Estimates of diabetes and its burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

de-Graft Aikins

Dodoo

Awuah

R. B.

Owusu-Dabo

Addo

Nicolaou

Buene

Mockenhaupt

F. P.

Danquah

Bahendeka

Meeks

Klipstein-Grobusch

Afrifa-Anane

Smeeth

Stronks

Agyemang

(2019). Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study. PLOS ONE, 14(4), Article e0214501. https://doi.org/10.1371/journal.pone.0214501

Elo

Kyngäs

(2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x

Fernández

Quan

Moffet

Parker

M. M.

Schillinger

Karter

A. J.

(2017). Adherence to newly prescribed diabetes medications among insured Latino and white patients with diabetes. JAMA Internal Medicine, 177(3), 371–379. https://doi.org/10.1001/jamainternmed.2016.8653

Giri

B. R.

Sharma

K. P.

Chapagai

R. N.

Palzom

(2013). Diabetes and hypertension in urban Bhutanese men and women. Indian Journal of Community Medicine, 38(3), 138–143. https://doi.org/10.4103/0970-0218.116349

Hennink

M. M.

Kaiser

B. N.

Weber

M. B.

(2019). What influences saturation? Estimating sample sizes in focus group research. Qualitative Health Research, 29(10), 1483–1496. https://doi.org/10.1177/1049732318821692

10.

A. Y.

Berggren

Dahlborg-Lyckhage

(2010). Diabetes empowerment related to Pender’s Health Promotion Model: A meta-synthesis. Nursing & Health Sciences, 12(2), 259–267. https://doi.org/10.1111/j.1442-2018.2010.00517.x

11.

Kansas Bhutanese Community Foundation (2009). https://bhutanesekc.org

12.

Lannon

S. L.

(1997). Using a health promotion model to enhance medication compliance. Journal of Neuroscience Nursing, 29(3), 170–178. https://doi.org/10.1097/01376517-199706000-00004

13.

Leininger

(2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189–192; discussion 200-181. https://doi.org/10.1177/10459602013003005

14.

LeMaster

J. W.

Broadbridge

C. L.

Lumley

M. A.

Arnetz

J. E.

Arfken

Fetters

M. D.

Jamil

Pole

Arnetz

B.B.

(2018). Acculturation and post-migration psychological symptoms among Iraqi refugees: A path analysis. American Journal of Orthopsychiatry, 88(1), 38–47. https://doi.org/10.1037/ort0000240

15.

Morello

C. M.

Hirsch

J. D.

(2017). Strategies for addressing the cost of nonadherence in diabetes. American Journal of Managed Care, 23(13 Suppl.), S247–S252. https://www.ajmc.com/view/strategies-for-addressing-cost-of-nonadherence-in-diabetes

16.

Njeru

J. W.

Boehm

D. H.

Jacobson

D. J.

Guzman-Corrales

L. M.

Fan

Shimotsu

Wieland

M. L.

(2017). Diabetes outcome and process measures among patients who require language interpreter services in Minnesota primary care practices. Journal of Community Health, 42(4), 819–825. https://doi.org/10.1007/s10900-017-0323-x

17.

Deenam

Pathumarak

(2013). Factors influencing eating behavior of people with diabetes in Bhutan. Journal of Science, Technology, and Humanities, 11(2), 129–138. https://www.thaiscience.info/Journals/Article/STHB/10970557.pdf

18.

Pender

N. J.

Murdaugh

C. L.

Parsons

M. A.

(2015). Health promotion in nursing practice (7th ed.). Pearson.

19.

Rezaei

Valiee

Tahan

Ebtekar

Ghanei Gheshlagh

(2019). Barriers of medication adherence in patients with type-2 diabetes: A pilot qualitative study. Diabetes Metabolic Syndrome and Obesity, 12, 589–599. https://doi.org/10.2147/dmso.S197159

20.

Roka

(2017). Adjusting to the New World: A study of Bhutanese refugees’ adaptation in the US. Journal of Sociology and Social Work, 5(2), 98–108. https://doi.org/10.15640/jssw.v5n2a11

21.

Sapkota

Brien

J. E.

Aslani

(2016). Nepalese patients’ perceptions of treatment modalities for type 2 diabetes. Patient Preference and Adherence, 10, 1777–1786. https://doi.org/10.2147/ppa.S113467

22.

Shakya

Kkarmacharya

B. M.

Shrestha

Kulseng

B. E.

(2018). Factors associated with medication adherence among type 2 diabetes mellitus patients in Nepal. Diabetes, 67(Supplement 1), 709-P. https://doi.org/10.2337/db18-709-P

23.

Shrestha

D. D.

(2015). Resettlement of Bhutanese refugees surpasses 100,000 mark. https://www.unhcr.org/en-us/news/latest/2015/11/564dded46/resettlement-bhutanese-refugees-surpasses-100000-mark.html

24.

South Asian Americans Leading together. (2019). Demographic snapshot of South Asians in the United States. https://saalt.org/wp-content/uploads/2019/04/SAALT-Demographic-Snapshot-2019.pdf

25.

UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet, 352(9131), 837–853. https://doi.org/10.1016/S0140-6736(98)07019-6.

26.

Zelniker

T. A.

Wiviott

S. D.

Raz

Goodrich

E. L.

Bonaca

M. P.

Mosenzon

Kato

E.T.

Cahn

Furtado

R. H. M

Bhatt

D. L.

Leiter

L. A.

McGuire

D. K.

Wilding

J. P. H.

Sabatine

M. S.

(2019). SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: A systematic review and meta-analysis of cardiovascular outcome trials. Lancet, 393(10166), 31–39. https://doi.org/10.1016/s0140-6736(18)32590-x

Understanding Medication Adherence in Bhutanese Refugees With Diabetes in a Midwestern City