Academic journal article Journal of Cultural Diversity

Overcoming Cultural Barriers to Diabetes Control: A Qualitative Study of Southwestern New Mexico Hispanics

Academic journal article Journal of Cultural Diversity

Overcoming Cultural Barriers to Diabetes Control: A Qualitative Study of Southwestern New Mexico Hispanics

Article excerpt

Abstract: This qualitative study examined the impact of cultural barriers on self-management of diabetes among Hispanic participants in LA VIDA (Lifestyle and Values Impact Diabetes Awareness), a diabetes intervention program in southwestern New Mexico. As part of the LA VIDA program evaluation, in depth interviews were conducted with 50 Hispanics who had participated in one or more activities, including diabetes education classes, grocery store tours, and support groups, and who had interacted with promotores (community health workers). LA VIDA participants reported that a sense of empowerment and increased self-efficacy enabled them to overcome cultural barriers related to the traditional Hispanic diet, lack of social support, and denial about having diabetes.

Key Words: Hispanics, Cultural Barriers, Empowerment, Self-efficacy, Fatalism, Diabetes Intervention, Promotores

LA VIDA (Lifestyle and Values Impact Diabetes Awareness), a community-based diabetes intervention program in southwestern New Mexico, targets Hispanics who have or are at risk for diabetes and their family members. The high incidence of diabetes among Hispanic individuals demands a better understanding of how culture affects diabetes control. Since 2002 to the present, with funding from the Centers for Disease Control and Prevention's REACH (Racial and Ethnic Approaches to Community Health) 2010 and REACH US, LA VIDA seeks to eliminate diabetes health disparities among Hispanics by implementing culturally relevant program activities. At the heart of LA VIDA, community health workers, called "promotores de salud" in Spanish, lead program activities and act as trusted navigators to help clients negotiate the health care system and support clients' efforts to control their diabetes. As part of a program evaluation of LA VIDA's effectiveness, this study examined the cultural factors that affected Hispanic participants' receptiveness to recommendations for diabetes self-management. The purposes of this study were to identify: l)cultural barriers to diabetes control among LA VIDA Hispanic participants and 2) their successful strategies that enabled mem to overcome these barriers.

LITERATURE REVIEW

Diabetes Health Disparities among Hispanics

The REACH 2010 Risk Factor Survey (2005) in Hidalgo, Luna, and Grant Counties found that 2004 rates of diabetes among Hispanics were twice as high as rates for all New Mexicans in 2003. When asked, "Have you ever been told by a doctor that you have diabetes?" a total of 14.1% of Hispanics reported that they had diabetes. In the three southwestern New Mexico counties, 14.7% of men and 13.6% of women reported that they had diabetes, while among all New Mexicans, 5.6% of men and 5.9% of women had diabetes. In New Mexico, the diabetes death rate among Hispanics was 2.1 times higher than that of non-Hispanic whites (New Mexico Department of Health, 2006). Among participants in the San Antonio Heart Study, not only was the incidence among Mexican-Americans twice that among non-Hispanic whites, but the rapid rise of diabetes among Mexican Americans was highly significant from 1987 to 1996 (Burke et al., 1999). Among all Hispanics in the United States from 1998-2002, the age-adjusted diabetes prevalence was 9.8% compared to 5.0% among non-Hispanic whites (Center for Disease Control and Prevention, 2004).

Theoretical Framework

Explanations of the personal agency that is essential for making favorable life style changes employ the concepts of a sense of control (BoI am, Hodgetts, Chamberlain, Murphy, & Gleeson, 2003), empowerment (Wallerstein, 2006), and self-efficacy (Bandura, 1997). A sense of lack of control over health emerges as an explanation for health disparities (Bolam et al., 2003), while empowerment in individuals' lives contributes to improved health outcomes (Wallerstein, 2006). Empowerment refers to people, organizations, or communities gaining mastery over their lives (Rappaport, 1987). …

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