Diabetes Symptoms, Health Literacy, and Health Care Use in Adult Latinos with Diabetes Risk Factors
Coffman, Maren J., Norton, Cynthia K., Beene, Lara, Journal of Cultural Diversity
Abstract: Purpose: This study examined the extent of undetected and untreated type 2 diabetes in a sample of recent Latino immigrants, and looked at the relationships among diabetes symptoms, blood glucose level, diabetes knowledge, health literacy level, and health care use.
Methods: Using a descriptive and correlational design, 144 Latino adults were interviewed.
Results: Many participants had diabetes and reported symptoms, but they were not aware of the disease and were not receiving adequate health care. Lack of diabetes knowledge, low health literacy, and barriers to health care prevented appropriate symptom responses.
Conclusions: Interventions that teach health literacy skills and diabetes symptom interpretation may improve health care use.
Key Words: Type 2 Diabetes, Diabetes Symptoms, Health Care Use, Health Literacy
According to the National Center for Health Statistics (2006), nearly 15% of Latino adults in the U.S. have type 2 diabetes, compared to 9% of non-Hispanic whites. Further, Latinos are more likely to suffer from serious diabetes complications, including amputations and retinopathy (Center for Disease Control and Prevention [CDC], 201 1) due, in part, to inadequate diabetes education and lack of access to preventive health care.
The Symptom Interpretation Model (SIM) explains individual reactions to the symptom experience, and the reasoning and behavioral responses that result (Teel, Meek, McNamara, & Watson, 1997). According to the model, when diabetes symptoms occur, an individual with adequate symptom experience, diabetes knowledge, and health literacy will be able to recognize, interpret, and respond to the symptoms. Health care services can then be accessed, leading to improved blood glucose control. Inaccurate symptom interpretation, however, may lead individuals to disregard symptoms, self-treat, or delay professional health care.
According to the SIM, the symptom experience includes a) sensory awareness of symptoms, b) interpretation of symptoms based on identification, knowledge, and reasoning, and c) the actions and behaviors that follow (Teel et al., 1997). Symptoms, defined as the "subjective, multidimensional awareness of an internal system disturbance to which meaning has been assigned" (Teel et al., p. 176), are interpreted and acted upon based on cultural beliefs and personal factors.
For Latinos, symptom awareness may be based on culturally defined explanatory models rather than biomedicai models. Latinos tend to explain diabetes based on their symptoms, while non Hispanic whites use biophysical explanations (Caban & Walker, 2006). For example, in one study, Mexican American women with type 2 diabetes described the disease as confusing and silent. To them, a lack of discernible symptoms indicated that the disease was either absent or under control (Alcozer, 2000; O'Connell et al., 1984; Phinney & Wallhagen, 2003). Conversely, the presence of diabetes symptoms was viewed as an indication that the disease had advanced or that complications were present (Alcozer, 2000).
Once there is awareness, the symptom experience is interpreted. According to Teel et al. (1997), symptoms are interpreted through a personal, cultural lens that influences associated meanings. Appropriate interpretation of symptoms is based on knowledge structures, which are exemplars or prototypes developed from past experiences. Inadequate diabetes knowledge and understanding in Latinos (Garcia, Villagomez, Brown, Kouzekanani, & Hanis, 2001) may inhibit appropriate development of knowledge structures.
Thus, Mexican Americans who have type 2 diabetes may incorrectly interpret serious symptoms as benign (Garcia, 2005). Further, they may make judgments without checking their blood glucose, even when they have blood glucose monitors and supplies (Brown, Upchurch, Garcia, Barton, & Hanis, 1998). In one study of symptoms in Mexican Americans with type 2 diabetes, though participants had markedly elevated glucose levels, only 50% reported symptoms and half did not think the symptoms were serious (Brown et al, 1998). …