Adherence to Type 2 Diabetes Treatment Protocols among Indigenous Women of Western Guatemala

By Goldín, Liliana; de Barrios, Linda Asturias et al. | Human Organization, Summer 2017 | Go to article overview

Adherence to Type 2 Diabetes Treatment Protocols among Indigenous Women of Western Guatemala


Goldín, Liliana, de Barrios, Linda Asturias, Jaccard, James, Satey, Elisa Liliana Xiap, Padilla, Diana, Mejía, Idalma, Mazariegos, Luisa, de León, Otto, Human Organization


The prevalence of Type 2 Diabetes (T2D) among indigenous peoples of Guatemala is considerable. In the many years that we have been conducting ethnographic research in the western highlands, we have encountered evidence of serious complications derived from the difficulties people with T2D have relative to their adherence to their treatment protocols. This population experiences the brunt of effects of untreated diabetes but often is unable to cope, afford, or deal with the required treatments. Some people simply do not seek help from experts until it is too late to prevent complications that can include blindness and loss of a limb.

The study was conducted to better understand the lack of patient adherence to medical protocols for treating Type 2 Diabetes among Maya women in western Guatemala with the hope that results would inform new strategies for improving adherence. The Hospital Regional de Occidente in Quetzaltenango is one of the public centers where some of the poorest individuals in the region go when they feel that the local (and limited) options in their communities are not sufficient to alleviate their ailments. The current study explored multiple facets related to aspects of disease control by eliciting patients' understanding of their diagnosis and treatment, attitudes towards adhering to treatment protocols, barriers and facilitators to adherence, and the views of physicians responsible for providing diagnosis and treatment. Patients and physicians also were asked to suggest ways in which treatment and control could be improved, with the idea that such questions would provide additional insights into the lack of adherence to prescribed protocols. We found most patients were confused about multiple aspects of their treatment. Women said they were told by physicians to change their lifestyle but were often unsure in what ways or were confused about whether they were, in fact, adhering to the physician-recommended behavioral protocols. Three themes emerged from the analysis: (1) problems associated with poor communication between patients and doctors, including issues of language use, (Maya vs. Spanish), length, style, clarity, and/or just the fact that it was difficult to recall so much information; (2) problems with low motivation to follow understood treatment protocols that resulted from few perceived advantages and multiple perceived disadvantages of performing the behaviors, low perceived ability to perform the behaviors, social pressures discouraging women from making changes in their lives, perceived stigma, and negative emotions associated with behavioral performance; and (3) problems for motivated women to translate that motivation into behavior because of encountered barriers that are difficult to overcome and make it hard to follow through with behavior (e.g., husbands not giving them money to buy medications or failing to remember to take medications every day). The identified problem areas were summarized in the form of a three process framework that reflected three imperatives, communicate-motivate-facilitate (CMF), to guide efforts to promote improved adherence to T2D treatment protocols among Maya women of Guatemala.

Context and Setting

Indigenous Maya die from T2D prematurely. The scope of the problem in developing countries more broadly should not be underestimated. Reports refer to diabetes as a global epidemic (Lipska 2014; Shaw, Sicree, and Zimmet 2009; WHO 2003). In developed countries, it is estimated that only about 50 percent of people with chronic diseases are able to control their illness (Gakidou et al. 2011). In Guatemala, the Ministry of Public Health estimated that one million people have diabetes. The areas with higher mortality rates from T2D are Guatemala City, Escuintla, Quetzaltenango, and Chimaltenango. A report from The International Diabetes Federation, Atlas, noted that over 7,200 people living in Guatemala died from this condition in 2012. According to a survey conducted by the University of San Carlos of Guatemala in 2010, 19 percent of adults twenty years and older had T2D (Martínez 2013). …

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