Integrative Review on Adherence in Haitians With Diabetes


Chronic kidney failure is a complex disorder that affects thousands of people every day. People from impoverished areas such as Haiti are especially vulnerable to the threat. Lacking the financial resources, as well as facing language difficulties and, thus, often being incapable of vocalizing their problem, they may face further aggravation of the disease, as well as develop comorbid disorders that will lead to an even worse patient outcome (Kwan, 2018). Using a transcultural model of care suggested by Madeleine Leininger, a nurse may identify the threat at the earliest stage of its development and manage it respectively, as shown in an article by Bivins (2017). In the case under analysis, the authors study the effects of using Leininger’s Transcultural Model for managing the needs of Haitians with diabetes. Because of the opportunities for evaluating a patient-nurse conversation that a case study provides, as well as the precise identification of the factors affecting the patient’s well-being, the article proves the importance of the model.

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In the abstract to his study, Bivins (2017) addresses the factors that served as prerequisites to the aggravation of the diabetes problem. Particularly, the issue of poverty and the lack of education in Haiti is described succinctly yet clearly. Furthermore, the author explains the importance of Leininger’s Transcultural Model as the framework for addressing the needs of Haitians suffering from diabetes. Thus, the problem, population, and goals of the paper are specified in the abstract, thus, making it a perfect introduction to the article.


Before proceeding to the description of his methods, Bivins (2017) provides a brief overview of the studies that address the problem of diabetes among Haitians. The author of the study explains that the issue of adherence as an important aspect of managing diabetes must be explored in depth. According to the definition offered by Bivins (2017), adherence implies following the set range of guidelines designed to maintain a stable positive condition in patients with diabetes (Bukhman et al., 2015). Furthermore, Bivins offers a rather accurate definition of diabetes, stressing the disruption in a patient’s metabolic processes as one of the key factors determining the development of the disorder. After emphasizing the impact that diabetes mellitus has had on people globally, Bivins (2017) continues to narrow his research down by focusing on Haitians.


The goal of the study is to determine the factors that inhibit the process of adherence and, thus cause a decline in the levels of health among Haitians. The problem is rendered with the help of Leininger’s Transcultural Model as the tool for understanding the culture-related impediments to proper care. Particularly, the model serves as the platform for developing a proper understanding of the Haitian concept of health. The insight that the model provides leads to the identification of the obstacles on the way to delivering healthcare services of proper quality to Haitians living in impoverished areas. Bivins (2017) stresses that the study also seeks to locate the tools for managing the issue and assisting Haitians in receiving proper care. In addition, Bivins (2017) tries to explore strategies for maximizing the possibility of a positive patient outcome in diabetes, in general.

Research Method

Since the question asked by Bivins is, in its nature, a qualitative one, the decision to use a review of the available literature as the primary tool for conducting the research seems legitimate. By studying multiple cases where the specified framework was utilized, Bivins was capable of evaluating the efficiency of the approach, in general, and detailing general trends in the application of the tool. Consequently, a generalized assumption regarding the overall usefulness of the tool could be made. The suggested method was not without flaws since it did not allow testing the model and implied a significant amount of subjectivity (American Diabetes Association, 2015). However, the overall use of the qualitative analysis is very competent. Bivins (2017) has managed to create a compelling assessment of the existing framework for promoting adherence in diabetes treatment.

Review of Literature

The overview of recent studies addressing the issue of diabetes in Haitians, as well as in people living below the poverty threshold, in general, is exhaustive and provides many important insights into the essence of the problem. Bivins (2017) explains that the specified concern has been viewed through the lens of a range of models and approaches. For instance, the adoption of dietary change is typically seen as one of the primary steps toward managing the issue (Kwan, 2018). The identified recommendation is also regarded as essential by other scholars (American Diabetes Association, 2015). Additionally, Bivins (2017) stresses the significance of incorporating several models into the process of altering people’s dietary habits. Particularly, the use of the “health belief model (HBM), the social cognitive theory (SCT), and the transtheoretical model (TTM)” (Bivins, 2017, p. 167) is encouraged.

Implications for Nursing Practice

The article is likely to have a significant impact on nursing practice, in general, and on the management of vulnerable populations’ needs, in particular. While the research explores the problem of handling the issue of diabetes, it also tackles a very important concern of healthcare accessibility and especially the quality of care for people from poor economic and social backgrounds. Because of budget constraints and gaps in the existing legal standards for care, people from poor households have very few chances for receiving proper care. Furthermore, because of the lack of patient-nurse communication, cross-cultural dialogue leaves much to be desired and incorporates an array of misunderstandings. The article, in turn, provides a framework for managing the specified concern.

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Because of the lack of a homogenous approach toward meeting the needs of patients from multicultural backgrounds and with the lack of financial resources, the management of diabetes becomes increasingly complicated. In Haiti, the healthcare system could benefit from removing barriers to adherence to the existing guidelines. In his paper, Bivins (2017) shows how the concern can be managed by adopting Leininger’s Transcultural Model and focusing on culture-specific needs. As a result, a framework for improving the quality is care is created. The research may have its flaws due to its qualitative nature, yet it gives a profound understanding of the needs of diabetic patients from different ethnic and cultural backgrounds. By enhancing communication between a patient and a nurse, one will be able to reduce the threat of fatal patient outcomes.


American Diabetes Association. (2015). Standards of medical care in diabetes – 2015 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 33(2), 97-111. Web.

Bivins, B. L. (2017, July). Integrative review on adherence in Haitians with diabetes. Nursing Forum, 52(3), 165-172. Web.

Bukhman, G., Bavuma, C., Gishoma, C., Gupta, N., Kwan, G. F., Laing, R., & Beran, D. (2015). Endemic diabetes in the world’s poorest people. The Lancet Diabetes & Endocrinology, 3(6), 402-403. Web.

Kwan, G. (2018). High poverty among patients with noncommunicable diseases in rural Haiti. Circulation, 137(Suppl. 1), 140. Web.

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"Integrative Review on Adherence in Haitians With Diabetes." StudyCorgi, 26 July 2021,

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StudyCorgi. "Integrative Review on Adherence in Haitians With Diabetes." July 26, 2021.


StudyCorgi. 2021. "Integrative Review on Adherence in Haitians With Diabetes." July 26, 2021.


StudyCorgi. (2021) 'Integrative Review on Adherence in Haitians With Diabetes'. 26 July.

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