Explanatory Models of Mexican-American Women with Type 2 Diabetes Living in the Colonias

Abstract

Type 2 diabetes (T2DM) affects more than 30 million Americans. Hispanics are more likely to be diagnosed with diabetes and are more likely to suffer from diabetes-related complications and mortality than non-Hispanic whites. Due to its large concentration of Mexican Americans, the U.S.-Mexico border has a higher prevalence of T2DM than the U.S. overall. Colonias, small unincorporated towns along the border that may lack infrastructure and/or resources, may be particularly vulnerable to the T2DM disparity. The T2DM disparity among Mexican Americans may persist due to a lack of cultural tailoring of T2DM care to this Hispanic subgroup, thus the care they receive may not be congruent with their sociocultural beliefs, values, and experiences. Little is known about Mexican Americans’ sociocultural beliefs and experiences regarding their T2DM diagnoses, particularly among the Mexican-American women who reside in the colonias near Las Cruces, New Mexico. Therefore, the purpose of this project was to use Kleinman’s Explanatory Model (EM) of Illness as a framework to better understand the beliefs about illness etiology, treatment (including use of herbs), and treatment goals of a small group of Mexican-American women with T2DM living in the colonias near Las Cruces, NM who are patients of the La Clinica de Familia (LCDF) organization in order to serve as a foundation for improving the T2DM care LCDF provides. This project utilized a qualitative descriptive design. Individual participant interviews were used to collect data and data was analyzed using content analysis. Seven women were interviewed. Overall, participants believed or had heard that stress can potentially cause T2DM, the need for insulin indicates more “severe” T2DM, insulin is useful for treating T2DM, and healthy eating and physical activity are important to prevent and manage T2DM, but did not believe or expressed ambivalence about the beliefs that insulin causes complications such as blindness or amputations and that herbs can be used to effectively treat T2DM. Suggestions for areas of potential future research and practice changes within the LCDF organization include: 1) further assessing all aspects of the EMs of T2DM of both the patients of LCDF and of the residents of the colonias near Las Cruces, NM at large, with particular focus on the use of herbs for T2DM treatment; 2) assessing LCDF healthcare providers’ and diabetes educators’ ability and willingness to elicit patients’ EMs; 3) incorporating questions into LCDF’s pre- diabetes self-management education (DSME) questionnaire to elicit the EMs of patients with T2DM; and 4) incorporating a formal way for LCDF healthcare providers and diabetes educators to more regularly assess patients’ DSME and support needs. Gaining a deeper understanding of the EMs, complementary healing practices, and DSME and self-management support needs of Mexican-American women with T2DM living in the colonias near Las Cruces, NM will allow the LCDF organization to combat the T2DM disparity among this population by designing tailored, patient-centered, and culturally-congruent treatment plans and DSME programs.