A Qualitative Study of Acculturation and Diabetes Risk Among Urban Immigrant Latinas

Abstract

Purpose The purpose of this qualitative study was to understand how acculturation influences diabetes risk among urban, immigrant Latinas (Hispanic women). Methods Five focus groups were conducted with 26 urban, immigrant Latinas who were at high clinical risk for developing diabetes. The focus group sessions were audiotaped and transcribed verbatim. The authors independently analyzed transcripts using an inductive method of open coding, and themes were established by consensus among authors. Results All of the participants were foreign-born and had low levels of acculturation. During the acculturation process, they noted changes in their lifestyle behaviors and the family context in which those behaviors are shaped. They reported that since living in the U.S., their improved economic circumstances led to increased consumption of less healthy foods and beverages and a more sedentary lifestyle. They also described changing family roles and responsibilities, including working outside the home, which constrained healthy food choices. However, they perceived that their position of influence within the family offered opportunities to help family members prevent diabetes. Conclusions Lifestyle interventions to prevent diabetes in Latinas should address their acculturation experiences, which impact family functioning and health behaviors related to diabetes risk. For example, given the perceived link between Latinas’ improved economic circumstances and their diabetes risk, prevention programs should incorporate strategies to help Latinas avoid adopting less healthy lifestyle behaviors that become affordable during the acculturation process.

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin

“…18,19 Findings from formative research informed minimal modifications to the Spanish-language Group Lifestyle Balance program participant handouts to increase their cultural salience for the target population. 15,20,21 The 24-session intervention was delivered in Spanish by one promotora to four groups of between five and nine participants, with each session lasting approximately 90 minutes. A second promotora provided logistic support during ILI sessions such as weighing participants and distributing printed materials.…”

The rationale, design, and baseline characteristics of PREVENT-DM: A community-based comparative effectiveness trial of lifestyle intervention and metformin among Latinas with prediabetes

“…39 Prior to modifying the GLB materials, we conducted formative research suggesting fast food and sugar-sweetened beverages as specific dietary targets prevalent in the target population. 12,40 In a qualitative study of Latinas with prediabetes, we identified social and cultural factors, such as changes in family roles and food preparation practices that participants believed to be related to their diabetes risk. 12 Based on these findings, we developed culturally-appropriate dietary self-monitoring tools and targeted messages about healthy behavior change in the Latino family context that were incorporated into the protocol.…”

“…12,40 In a qualitative study of Latinas with prediabetes, we identified social and cultural factors, such as changes in family roles and food preparation practices that participants believed to be related to their diabetes risk. 12 Based on these findings, we developed culturally-appropriate dietary self-monitoring tools and targeted messages about healthy behavior change in the Latino family context that were incorporated into the protocol. (Appendix 1) This process of adapting the GLB protocol was also informed by feedback on the intervention materials given by the promotoras.…”

“…Based on our pilot data and findings from DPP, 116 we hypothesize that both the lifestyle intervention and metformin will result in significant weight loss relative to standard care. We chose Latinas as the target population because: 1) they have the highest risk of developing diabetes relative to Hispanic men and other demographic groups;, 2) their culturally-shaped influence on family members’ lifestyle behaviors may result in a multiplying effect of the study interventions; 12–14 and 3) previous DPP translation studies across all racial/ethnic groups have included mostly women, while citing challenges to engaging men. 9 This paper presents the rationale, design, and baseline characteristics of this novel comparative effectiveness study, called the Promotora Effectiveness Versus Metformin Trial (PREVENT-DM).…”

Psychosocial aspects of type 1 diabetes in Latino- and Asian-American youth

“…Some Latino parents consider that providing food for their children is an important aspect of good parenting (58)(59)(60), but this value can promote childhood obesity. A study among Latino women at risk for diabetes reported that improved economic conditions since immigration facilitated access to "high status foods" but, unfortunately, a less healthy diet as well (61). Lower acculturation (as measured by linguistic status) in Latino mothers was associated with increased BMI in their children (62).…”