Diabetes Causation Beliefs Among Spanish-Speaking Patients

Susto as a cultural conceptualization of distress: Existing research and aspects to consider for future investigations

Among the cultural conceptualizations of distress, susto is defined in the DSM-5 as "a cultural explanation of distress and misfortune in Latin America that refers to an illness attributed to a terrifying event that causes the soul to leave the body and leads to unhappiness and illness, as well as difficulties in performing key social functions" (American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC: APA, p. 836). Thus, susto represents a cultural explanation that encompasses the symptoms of various mental disorders and physical diseases. We analyzed the descriptions of susto from different scientific fields and related them to definitions of DSM-5 syndromes. Three syndromic subtypes of susto show a symptomatic overlap with depression, post-traumatic stress disorder (PTSD) and somatic disorder. However, linguistic metaphors describing symptoms and perceived causes that are specific for Latin American culture support the concept of susto as a specific idiom of distress (e.g., loss of soul, shadow or ajayu; sunken, closed or white eyes; jumping and screaming in the night; being thrown to the ground). In addition, if diagnostic criteria are met for mental disorders, then susto describes a perceived cause of psychopathological states (e.g., depressive disorder, PTSD, somatic disorder, panic disorder, generalized anxiety disorder). Future research with people who have experienced susto is needed to clarify whether susto precedes the onset of other mental disorders (perceived cause) or whether it is a way of designating distress (idiom of distress).

Famalismo Primero and Puerta Cerrada in Self-Managing Diabetes Among Hispanics: A Qualitative Meta-Synthesis

Introduction:

Type 2 diabetes (T2D) prevalence is increasing at concerning rates for Hispanics. Researchers have attempted to understand why through quantitative or qualitative studies. This meta-synthesis examines qualitative studies concerning barriers and facilitators that Hispanics face while managing their diabetes.

Method:

Noblit and Hare’s (1988) defined method of analysis was used to synthesize 15 qualitative studies on Hispanics’ diabetes self-management.

Results:

Findings revealed two themes: (a) famalismo primero and (b) puerta cerrada, translating to family first and closed door, respectively. In famalismo primero, Hispanics with T2D prioritize family, and receive support, motivation, and knowledge from them first; puerta cerrada is tied to barriers such as cost of services and patient–provider relationships.

Discussion:

Inclusion of family in diabetes self-management provides support and motivation for Hispanics. Hispanics experience barriers to access health care that may interfere with diabetes self-management, which need to be addressed to promote health equity.

Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study

BACKGROUND AND AIMS

Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia.

METHODS

The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged.

RESULTS

The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators.

CONCLUSION

Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.

"My problems aren't their fault": Mexican American women managing diabetes while caring for grandchildren

Diabetes affects many aspects of family life for the Mexican American (MA) population. Caregiving grandmothers, the traditional family nurturers, are often simultaneously managing their type 2 diabetes (T2DM). The purpose of this qualitative descriptive study was to describe the perceptions of MA grandmothers managing T2DM while caring for a grandchild. Eight participants were interviewed. Participants consistently reported feeling a personal responsibility for their T2DM self-management as well as for the health and wellbeing of their families, including their grandchildren. Regardless of associated caregiving stress, grandchildren were described as the main source of positive motivation for T2DM self-management.

The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms

AIMS

The purpose of this study was to examine how older Latina women emotionally experience type 2 diabetes mellitus and interactions with care providers using a grounded theory approach.

METHODS

Sixteen English-speaking, Latina women, 60 years and older, diagnosed with type 2 diabetes mellitus and experiencing symptoms of depression or anxiety participated in 21 phone interviews guided by a semi-structured interview guide. Data was collected and analyzed using Grounded Theory methodology; theoretical sampling was used to achieve data saturation.

RESULTS

Participant data informed the creation of a theory, The Secret Self-Management Loop, with four interconnected phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and 4) engaging in secret self-management. These phases reflected participants' lost trust in their providers and the medical system, resulting in undisclosed self-management strategies that complicated clinical management of their type 2 diabetes mellitus diagnosis. Primary sources of loss of trust were interactions that lacked empathy or caused them to question their providers' motivation.

CONCLUSION

The Secret Self-Management Loop negatively influences patient disclosure and distorts providers' ability to adequately render care for this group.

Health and Type 2 Diabetes Perspectives of At-Risk, Mexican-Origin Males (HD-MxOM): a Qualitative Study

OBJECTIVE

To investigate perspectives of diabetes, nutrition, and health among underrepresented Mexican-origin males and elucidate on contributing factors of type 2 diabetes disparities.

RESEARCH DESIGN

Audio-recorded, semi-structured interviews were conducted with 15 native Spanish-speaking, Mexican-origin males. Men were between the ages of 40 and 64 and at risk for type 2 diabetes-defined as > 40 years of age, BMI > 25, and sedentary over the last 3 months. Data collected included clinical measures (height, weight, waist circumference, blood pressure) and demographic characteristics (years living in the U.S., marital status, employment, occupational physical activity, income, educational attainment, and average physical activity levels). The audio recordings, each lasting approximately 60 min, were transcribed verbatim and underwent three-cycle coding with analysis for codebook formation, categorization, and thematic extraction.

RESULTS

Barriers to engaging in health behaviors among Mexican-origin males include poor understanding of diabetes and nutrition, unreliable sources of health information, and socioeconomic status. Enablers of health neglect include intense perceptions of diabetes severity and a reactive health culture rooted in medical machismo and valemadrismo. Perspectives of personal responsibility and the desire to learn through culturally specific recommendations detail potential facilitators of health behaviors.

CONCLUSION

The data convey a network of sociocultural factors that inhibit health prioritization and promote disease misconceptions among Mexican-origin males. Pragmatic, culturally tailored education represents serviceable strategies for health promotion and diabetes prevention. These findings explicate cultural considerations for educators and clinicians seeking optimization of programs and clinical interactions with Mexican-origin men.

The Space Between: Transformative Learning and Type 2 Diabetes Self-Management

INTRODUCTION

Immigrant populations experience higher type 2 diabetes mellitus (T2DM) prevalence rates and worse health outcomes secondary to T2DM than native-born populations. But as the largest immigrant population in the United States, the experience of T2DM diagnosis and self-management among Spanish-speaking, limited English-language proficient Latinx immigrants remains largely unexamined. This study used semistructured interviews to explore these phenomena among a cohort of 30 recent Latinx immigrants.

METHOD

All aspects of data collection were conducted in Spanish. Quantitative and qualitative data were collected. Data analysis included descriptive statistical procedures. Qualitative data analysis was conducted using a grounded theory approach.

RESULTS

Patterns in the data analysis of 30 interviews identified accepting T2DM as a common transitional process that required significant changes in individuals' self-perspective and ways of being. Accepting T2DM was identified by the participants as a precursor to treatment initiation. And while for most participants this transition period was brief, for some it took months to years. Distinct transitional stages were identified, categorized, and considered within the context of several theoretical orientations and were observed to align with those in transformative learning.

CONCLUSION

Understanding differing responses and processing of a T2DM diagnosis could be leveraged to better support patients' acceptance and transition into treatment.

Hispanic Families’ Action Plans for a Healthier Lifestyle for Diabetes Management

Purpose

The purpose of this study was to conduct focus groups with Hispanic patients with type 2 diabetes and their family members who participated in a culturally tailored, family-based diabetes intervention about their action plans for a healthier lifestyle.

Methods

Five separate focus groups were led in Spanish by an experienced bicultural/bilingual moderator. The audiotaped sessions occurred at the end of the 8-week diabetes educational program. Data were transcribed in Spanish and translated into English. Qualitative content analysis was used to analyze the findings.

Results

Eighty-four Hispanic adults participated with an equal representation of patients with diabetes and family members. Most persons were female (63.1%) and the majority of persons were born in Mexico. The mean (SD) age of participants was 44.2 (14.3) years. Six themes emerged from the data: healthier eating habits, increasing physical activity, taking care of my sugar, coping with emotions, for the family, and empowerment and increased self-efficacy.

Conclusions

Hispanics created action plans that promoted healthier lifestyle behaviors individually and as a family. This type of behavior change may result in better diabetes management and fewer complications. Research studies are needed to assess the sustainability of action plans and their impact on glycemic control and diabetes risk factors. Additional studies are needed to address emotional eating and mental health factors.

Susto, Coraje, y Fatalismo: Cultural-Bound Beliefs and the Treatment of Diabetes Among Socioeconomically Disadvantaged Hispanics

Hispanics are disparately affected by diabetes. Treating socioeconomically disadvantaged Hispanics is challenging due to economic and cultural barriers. Health care providers must understand that cultural beliefs about medicine and disease may have an impact on how diabetes treatment is viewed. Concepts such as susto (fright), coraje (anger), and fatalismo (fatalism) are common cultural beliefs. If these beliefs are not well understood by the health care provider, recommendations for treatment are likely to be discarded. To dismantle cultural barriers between the patient and the health care provider, there are several strategies that a health care provider can implement. For instance, a health care provider must develop trust with the patient. The health care provider could also engage a family member or promotora or promotor (community health worker) in the conversation. Furthermore, if the cultural barriers are significant, the patient may be best served by receiving treatment from someone with a better understanding of his or her background. Thus, a referral may be appropriate.

The associations of illness perception with metabolic control (HbA1c) among type 2 diabetes mellitus patients in a district hospital

OBJECTIVES

Despite the availability of a wide selection of anti-diabetic treatments, many type 2 DM (T2DM) patients still do not have controlled glucose levels. In addition to pharmacological intervention, patients' own implicit beliefs about their illness should be targeted for health intervention. Thus, we conducted a quantitative study to evaluate the associations between illness perception (IP) domains and metabolic control (HbA1c) of T2DM patients in Selama Hospital and to identify patients' perceptions of the causal T2DM factors.

METHOD

A cross-sectional study was conducted in the outpatient department of Selama Hospital from October to December 2015. A total of 200 T2DM patients were recruited using systematic random sampling. A self-administered validated questionnaire consisting of three sections was used, and the data were analysed using SPSS version 18. The associations between eight IP domains and HbA1c were evaluated via multiple linear regression. P values <0.05 were considered significant.

KEY FINDINGS

The analysis included data from 200 respondents with a mean age of 57.7 years (SE = 9.8). The majority were women (64.5%) and Malays (86%) with a primary school education (43.5%) and a family history of diabetes (53.5%). The median duration of illness was 5 years (IQR = 7), and the median HbA1c level was 8.15% (IQR = 3.1). The mean score for the eight IP domains was 33.7 (SE = 8.43) out of a total score of 80. Using multiple linear regression, HbA1c was found to be significantly associated with IP domains of identity symptoms at 0.221 (95% CI 0.083-0.358). Moreover, 79.4% of patients ranked diet and eating behaviour as the main factor for T2DM.

CONCLUSION

The IP domain of identity symptoms was significantly correlated with T2DM metabolic control. By understanding patients' IP, healthcare providers can focus on behavioural approaches to managing T2DM patients. Steps must be taken to educate patients about the importance of diet control in managing T2DM.

Perceptions of Multiple Sclerosis in Hispanic Americans: Need for Targeted Messaging

BACKGROUND

Illness perceptions have been reported to be important determinants of multiple sclerosis (MS)-related well-being. Hispanic culture is defined by strong cultural beliefs in which illness is often perceived to arise from strong emotions. Understanding the perceptions of MS in Hispanic Americans may provide a better understanding of cultural barriers that may exist. The purpose of this study was to describe Hispanic American perceptions of MS.

METHODS

We gathered information from semistructured interviews, focus groups, and participant responses from the University of Southern California Hispanic MS Registry. This information was then stratified into a matrix of environmental, biological, and sociocultural determinants. Differences were examined by place of birth, treatment preference, and ambulatory difficulty. Logistic regression was used to investigate the relationship between sociocultural perceptions, place of birth, and ambulation.

RESULTS

Most participants were female (n = 64, 61%), US born (n = 64, 61%), and receiving treatment for MS. Participants cited environmental and sociocultural perceptions, with significant differences noted by place of birth. Sociocultural factors such as strong emotions were almost four times more commonly perceived in immigrants compared with US-born participants (adjusted odds ratio, 3.66; 95% confidence interval, 1.12-11.90; P = .03). Male, low-education, and low-income participants were also more likely to perceive MS to be a result of strong emotions, but these differences were not statistically significant.

CONCLUSIONS

Hispanic American perceptions of MS differ by place of birth, with reports of cultural idioms more common among immigrants, which could affect disease management. These findings may be useful in designing educational interventions to improve MS-related well-being in Hispanic populations.