Diabetes self-management: Perspectives of Latino patients and their health care providers☆
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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For more information on the Reflective Practice section please see: Hatem D, Rider EA. Sharing stories: narrative medicine in an evidence-based world. Patient Education and Counseling 2004;54:251–253.