Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants

Abstract

This article describes the quantitative findings of a mixed-methods study that examined the relationship among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes self-management among recent Spanish-speaking, limited English proficient immigrants to the US. This population is at risk for both a higher incidence of disease and increased barriers to successful disease management compared to the general US population. Distinguishing aspects of this study compared to the available literature are the comprehensive nature of the data collected, the theoretical component, and the analysis and modeling approach. Social cognitive theory provides the framework for the study design and analysis. An innovative community-based recruiting strategy was used, a broad range of physiological measures related to health were observed, and instruments related to knowledge, self-efficacy, and healthy lifestyle behaviors were administered orally in Spanish to 30 participants. A broad range of statistical analysis methods was applied to the data, including a set of three structural equation models. The study results are consistent with the importance of education, health knowledge, and healthy lifestyle practices for type 2 diabetes self-management. With the usual cautions associated with applying structural equation modeling to modest sample sizes, multiple elements of the posited theoretical model were consistent with the data collected. The results of the investigation of this under-studied population indicate that, on average, participants were not effectively managing their disease. The results suggest that clinical interventions focused on improving knowledge, nutrition, and physical activity, reducing stress, and leveraging the importance of interpersonal relations could be effective intervention strategies to improve self-management among this population.

Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

“…146 Selected studies have examined health literacy using qualitative and quantitative methods to investigate the relationship between health literacy and diabetes mellitus knowledge, acculturation, and access to care. [147][148][149][150] However, interventions that improve access to language-appropriate services and health literacy support for patients with limited English proficiency are needed. 151…”

Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus

“…Language barrier was identified as the most important factor influencing lack of patient–physician communication, contributing to poor diabetes knowledge, and self-management ( 14 ). In the United States, Hispanic and Asian patients reported poor glycemic control and worse health outcomes ( 15 – 17 ). Due to mutual language-concordant care provided by foreign-trained physicians, limited English proficiency became an independent factor in glycemic control data analysis among immigrants ( 15 , 18 ).…”

“…Low education and diabetes knowledge were found to be important limiting factors for achieving HbA1c <7%. The study concluded that the majority of participants did not effectively manage their disease ( 17 ).…”

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

“…The work performed to meet these objectives is part of a study for which quantitative (Smith-Miller, Berry, DeWalt & Miller, 2015) and qualitative (Smith-Miller, Berry & Miller, 2017) aspects have been reported. However, neither of these previous publications specifically explored the occurrence and cause of delayed treatment and self-management among participants.…”