Diabetes self-management: Perspectives of Latino patients and their health care providers

https://doi.org/10.1016/j.pec.2006.12.003Get rights and content

Abstract

Lifestyle modification programs tailored to experience, culture, psychosocial characteristics, and world-view can improve knowledge, self-care behaviors, and glucose control among Latinos with diabetes. Few data exist, however, on improving diabetes self-management among Latinos. In addition, views and practices of practitioners caring for these patients have received little attention.

Objective

This study describes findings from qualitative research to inform the refinement of self-management interventions tailored to Latino patients with type 2 diabetes.

Methods

Two practitioner focus groups assessed perceptions of patients’ knowledge, attitudes, and behaviors. Four patient focus groups examined knowledge, beliefs, practices, barriers, and facilitators. Data were transcribed and subjected to content analysis.

Results

Thirty-seven patients seeking care at a community clinic participated, along with 15 health care practitioners. Important knowledge gaps regarding diabetes causation and self-management were identified. Negative attitudes towards self-management were common among patients. Key facilitators included strong religious faith and support of medical practitioners. Families both facilitated and prevented adoption of self-management practices.

Conclusion

This study provides unique insights into the knowledge, attitudes, practices, and perceived barriers facing Latino patients and their providers regarding diabetes self-management.

Practice implications

Study findings underscore the need to develop tailored programs for this population and to train practitioners on their implementation.

Introduction

Differences in access to medical care do not fully explain the disparities between Latinos and whites who have diabetes [1], as glycemic control is poor even among Latinos receiving treatment [2]. Another factor explaining these differences may be the limited success of traditional provider-directed intervention models among Latinos [3]. Such approaches frequently use individually-oriented theories that fail to recognize the importance of family values and socio-cultural beliefs [4]. Empowerment programs that emphasize patients’ role in disease management have been proposed, but supporting data are limited for Latinos [5], [6], [7].

Studies have demonstrated the efficacy of lifestyle-based diabetes modification programs [8], [9], [10], [11]. Tailoring programs to experience, culture and other characteristics has improved diabetes management among Latinos [11], [12]. The major subgroups that make up Latinos are Mexican Americans, Puerto Ricans, and Cubans. Each of these groups represents a culturally distinct subpopulation. The prevalence of diabetes and its risk factors (diet and other health practices, income, health status, and health outcomes) can differ in these populations [13], [14], [15]. Both nationally, and in the state of Massachusetts specifically, Puerto Ricans have higher rates of diabetes than Mexican Americans or Cubans [15], [16], [17].

Despite this, few data exist for Puerto Rican populations, the largest Latino group in the northeast US [11], [17], [18], [19], [20], [21]. In addition, views and practices of health care providers caring for Puerto Rican patients with diabetes have received little attention. This paper describes findings from qualitative research to inform tailoring of diabetes self-management programs for Latino, particularly Puerto Rican, patients.

Section snippets

Design

Four patient and two practitioner focus groups were conducted following Institutional Review Board approval. Focus groups have been used successfully to explore diabetes self-management among Latinos [18], [22], [23] and to examine providers’ perspectives regarding the management of patients with multiple risk factors [24] and with Latino patients specifically [4].

Setting and study participants

The study was conducted at the Health Center in Holyoke, Massachusetts. Holyoke has the third highest proportion of Latinos in

Results

Thirty-seven patients and 15 practitioners participated in focus group sessions (see Table 1). All patients identified themselves as Puerto Rican, except one man from Colombia and one woman from the Dominican Republic. Length of time in the US varied from recent arrival to many years. On average, patients were in their mid-fifties. Older patients had less education (4.4 years) compared to younger patients (9.6 years). Patients in this study had diabetes for an average of 7.6 years, and mean

Discussion

This qualitative study provides insight about beliefs, attitudes and behaviors of Latino patients and their practitioners regarding diabetes self-management. These findings confirm previous reports regarding patient knowledge and attitudes [18], [20], [21], [23]. All study participants demonstrated some knowledge about diabetes and self-management, although misunderstandings regarding causation were identified across all ages and educational levels.

Patients in this study expressed a perception

Acknowledgements

Funding for this study was provided by the Robert Wood Johnson Foundation (grant #047914). We thank the patients, staff, and providers at the Holyoke Health Center for their time and commitment. Ongoing assistance from Dawn Heffernan, Sally Neuner, and Patricia Sarvela is also gratefully acknowledged.

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