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

Abstract

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.

The Role of Family in Diabetes Management for Mexican American Adults

“…These results emphasize that family provides varying types of support for diabetes self-care behaviors, and often is a motivator to improving self-management behaviors. Similar studies have noted grandchildren, spouses, and other family members as motivation ( Hu et al, 2013 ; Perez-Brescia et al, 2022 ; Rascón et al, 2022 ; Schmittdiel et al, 2018 ). Despite this knowledge, the proportion of Mexican Americans with poorly controlled T2DM (Hemoglobin A1C > 9%) remains almost double that of non-Hispanic whites ( CDC, 2023 ).…”

“…These results emphasize that family provides varying types of support for diabetes self-care behaviors, and often is a motivator to improving self-management behaviors. Similar studies have noted grandchildren, spouses, and other family members as motivation (Hu et al, 2013;Perez-Brescia et al, 2022;…”