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Borja S, Valdovinos MG, Rivera KM, Giraldo-Santiago N, Gearing RE, Torres LR. "It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:148. [PMID: 38397639 PMCID: PMC10887805 DOI: 10.3390/ijerph21020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a diagnosis of diabetes and depression or were closely associated with someone who did. This study identified key individual and structural barriers and facilitators affecting healthcare access and treatment for Latinos living with comorbid diagnoses. A thematic analysis revealed structural barriers to healthcare access, including financial burdens and navigating healthcare institutions. Personal barriers included fears, personal responsibility, and negative family dynamics. Facilitators included accessible information, family support, and spirituality. These findings underscore the need to address these multi-level factors and for healthcare institutions and providers to actively involve Hispanic community members in developing services and interventions.
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Affiliation(s)
- Sharon Borja
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA;
| | | | - Kenia M. Rivera
- Department of Psychology, University of Denver, Denver, CO 80208, USA;
| | | | - Robin E. Gearing
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA;
| | - Luis R. Torres
- School of Social Work, University of Texas, Rio Grande Valley, Edinburg, TX 78539, USA;
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Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
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Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Hispanic Acculturation and Gender Differences in Support and Self-Efficacy for Managing Diabetes. DIABETES EDUCATOR 2016; 42:315-24. [DOI: 10.1177/0145721716640905] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to determine whether perceived support, social norms, and their association with self-efficacy varied by gender and language-based acculturation in Hispanic men and women with uncontrolled type 2 diabetes mellitus (T2DM). Methods A cross-sectional, secondary analysis of baseline survey data from a randomized control trial. Participants were 248 Hispanic patients from 4 community health centers who participated in a culturally targeted intervention for diabetes management. Quantitative statistical methods were used, including chi-square analyses, one-way ANOVA, and multiple regression. Results Gender and language both moderated the relationship between social factors and self-efficacy. Regardless of language, better perceived support was associated with improved self-efficacy in women but not men. Dietary norms were associated with self-efficacy in English-speaking men and women, while physical activity norms were associated with self-efficacy for Spanish-speaking women only. Conclusions This study builds on previous research by exploring the extent to which the social context of diabetes self-management may vary in its effects depending on gender and acculturation. The findings revealed potentially important differences based on both gender and language, suggesting that interventions must be designed with these differences in mind. Diabetes-specific support from family members, especially spouses, may be especially important for Hispanic women. For both men and women, it may be effective to find creative ways of involving the family in creating healthier social norms and expectations.
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Affiliation(s)
- Carol L. Mansyur
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Luis O. Rustveld
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Susan G. Nash
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Maria L. Jibaja-Weiss
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
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Marquez B, Anderson A, Wing RR, West DS, Newton RL, Meacham M, Hazuda HP, Peters A, Montez MG, Broyles ST, Walker M, Evans-Hudsnall G. The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes. Obesity (Silver Spring) 2016; 24:568-75. [PMID: 26833676 PMCID: PMC4769665 DOI: 10.1002/oby.21382] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/23/2015] [Accepted: 10/12/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. METHODS Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. RESULTS Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. CONCLUSIONS Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.
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Affiliation(s)
- Becky Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
| | - Andrea Anderson
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital and Brown University, Providence, RI
| | - Delia S. West
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Robert L. Newton
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Maria Meacham
- Southwestern American Indian Center, Phoenix, Arizona and Shiprock, New Mexico
| | - Helen P. Hazuda
- Department of Medicine, Division of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Maria G. Montez
- Department of Medicine, Division of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Stephanie T. Broyles
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Martha Walker
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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