Coping with diabetes stress among adults in rural Dominican Republic: “I don’t think about it”

Abstract

Objectives As type 2 diabetes prevalence increases across Latin America, understanding local approaches to coping with diabetes stress is essential to providing care that incorporates patients’ values and preferences. This study explored a local phenomenon, “ no le doy mente” (I don’t think about it), used by adults with type 2 diabetes in the Dominican Republic to cope with diabetes stress. Methods We conducted 19 qualitative in-depth interviews with adults with type 2 diabetes (10 men, 9 women) recruited from one rural clinic. Using an inductive analytic approach including iterative coding, memos, and matrices, we identified reasons, strategies, and perceived benefits of not thinking about type 2 diabetes among participants. Results Participants described not thinking about diabetes as an active process to maintain a sense of normalcy despite significant life changes following diagnosis. They avoided thinking about diabetes by staying busy, proactively managing type 2 diabetes through diet and medication, and turning to their faith. Participants perceived that enacting no le doy mente helped to protect their overall health and well-being. Discussion Future research should investigate provider perceptions of no le doy mente to align patient and provider communication and mindfulness-based stress reduction as a way to support people with type 2 diabetes avoid dwelling on negative thoughts about diabetes.

“If They Give Their Mind to HIV, They Don’t Last as Long”: An Explanatory Model of HIV Infection in a Limited-Resource Setting Informs Person-Centered Care

“…For instance, Stonbraker et al identified the same sentiment in a separate study conducted at the same research site in the Dominican Republic (Stonbraker, Arcia, et al, 2017). Sadeghzadeh et al, found that Dominican participants living with type 2 diabetes felt diabetes was worse than HIV because of the extensive lifestyle modifications that diabetes requires for successful management (Sadeghzadeh et al, 2021). PLWH living outside the Dominican Republic express this sentiment as well.…”

“…Identity reformation allows people to confront their initial fear and/or embarrassment regarding their diagnosis and establish a new sense of self that promotes function and disease management (Aryal, 2018;Ho & Goh, 2017;Laws, 2016). The presence of this transformation has been observed in other Dominican PLWH (Barrington et al, 2018) as well as Dominicans living with type 2 diabetes (Sadeghzadeh et al, 2021). How quickly individuals complete their transformation likely depends on individual factors such as their frame of mind, self-esteem, level of social and professional support, and/or their level of religiosity.…”

“…In our study, participants clearly indicated that “giving your mind to” HIV quickly leads to an unhappy life, non-adherence to antiretroviral therapy, and in some cases, rapid death. This concept of “thinking too much” has been identified in the Dominican Republic (Sadeghzadeh et al, 2021), Haiti (Kaiser & McLean, 2016), and in several other sites worldwide (Kaiser et al, 2015). Although translated and experienced differently across languages and cultures, the underlying sentiment of this concept refers to pervasive and anxious thoughts, and may be a proxy for depression (Kaiser et al, 2015; Lewis-Fernández & Kirmayer, 2019).…”

Provider perspectives on emotional health care for adults with type 2 diabetes mellitus in the Dominican Republic

“…Qualitative studies conducted in the Dominican Republic found that diabetes-related stress begins at diagnosis and persists throughout the self-management process [13]. Furthermore, people with T2D reported that they often experienced a significant emotional burden as a result of their T2D; however, they lacked sufficient emotional support to cope with this emotional burden [13,17,18].…”

“…Participants' mean age was 52 and they had worked at the clinic for a range of 1-8 years. Informed by our past research in this setting [13,17,18], we wrote the interview guide in Spanish and organized it according to the study's three main topics: 1) how providers described the emotional burden of diabetes; 2) how they described their role in supporting the emotional health needs of patients; and 3) barriers to integrating emotional support into routine clinical care.…”