Diabetes: The Layperson’s Theories of Causality

Abstract

The authors examine laypersons' perspectives of illness: the content of causal explanations of diabetes and differences in explanations according to gender. Qualitative research was carried out in Guadalajara, Mexico. A nonprobabilistic sample of 20 diabetic individuals participated in interviews, and the content of the interviews was analyzed. On the origin of their condition, participants offered explanations that match neither the biomedical model nor any other formal causal theory. Participants attributed the onset of diabetes to socioemotional circumstances linked to their life experiences and practices. Men attributed causality to work and social circumstances outside the home; women attributed it to family life and domestic circumstances. The authors discuss how lay theories can be useful for the reorganization of health services.

Qualitative research in nutrition and dietetics: data collection issues

“…Interviews involving more than one participant have been used to successfully in nutrition research (e.g. Mercado‐Martinez & Ramos‐Herrera, 2002; Gronhoj & Olander, 2007) but do require skill to moderate well.…”

Speaking through Diabetes:

“…Because most of the research about patient explanatory models for diabetes addresses beliefs among Latin American populations (Coronado et al 2004; Hunt et al 1998; Jezewski and Poss 2002; Mercado‐Martinez and Ramos‐Herrera 2002; Weller et al 1999), there is a presumption that ethnicity may be the key variable contributing to the construction of such models, as opposed to other social, cultural, behavioral, psychological, and physiological factors. However, Schoenberg and colleagues (2005) demonstrate that low socioeconomic status patients of American Indian, African American, and Euro‐American descent were as likely to construct explanatory models that identify social distress as a cause of diabetes as those of Mexican American descent.…”

“…What seems to be most unique about Mexican and Mexican American explanatory models for diabetes is the powerful culturally elaborated idioms through which emotional experiences are frequently expressed. The most common idioms reported in these models include susto, an emotion roughly translated as fright and linked with acutely stressful experiences such as a car accident or being held at gunpoint, and coraje, an emotion roughly translated as rage or anger associated with prolonged forms of distress such as child abuse, domestic violence, and betrayal (Mercado‐Martinez and Ramos‐Herrera 2002).…”

“…Although cultural consensus analysis indicates that Mexican and Mexican American explanatory models often identify at least one form of stress or emotion as a cause of diabetes (Weller et al 1999), the construction of these models appears to vary between men and women. For example, Mercado‐Martinez and Ramos‐Herrera (2002) found that although women commonly report prolonged stressors as causes of diabetes, men are more likely to report acute stressors situated within larger contexts of chronic stress. Results from the present study, discussed below, follow a similar trend.…”

“…Results from the present study, discussed below, follow a similar trend. It is likely that such gender differences in diabetes narratives are related to larger trends in which Mexican or Mexican American women appear more vulnerable to sources of distress in the domestic sphere, involving family members, whereas men more often report distress originating outside the home and involving non–family members (Baker et al 2005; Lown and Vega 2001; Mercado‐Martinez and Ramos‐Herrera 2002). This gender differential is consistent with patterns among other cultural groups as well, in which social and political constraints tend to make women most vulnerable to suffering associated with instability, disruption, loss of control, and betrayal in the family sphere; in such contexts, women appear most likely to employ idioms of distress (Hunt 1998; Guarnaccia 1992; Nichter 1981).…”