Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language–proficient Latinx immigrants face additional challenges.
Methods:
Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language–proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females.
Results:
Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol.
Consumption:
Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices.
Conclusion:
Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.
AlbrechtS. S.Mayer-DavisE.PopkinB. M. (2017). Secular and race/ethnic trends in glycemic outcomes by BMI in US adults: The role of waist circumference. Diabetes Metabolism Research and Reviews, 33(5). https://doi.org/10.1002/dmrr.2889
2.
American Diabetes Association. (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, dci180007. https://doi.org/10.2337/dci18-0007
3.
American Diabetes Association. (2020a). 6. Glycemic targets: Standards of medical care in diabetes—2020. Diabetes Care, 43(Supplement 1), S66–S76. https://doi.org/https://doi.org/10.2337/dc20-S006
4.
American Diabetes Association. (2020b). 14. Management of diabetes in pregnancy: Standards of medical care in diabetes—2020. Diabetes Care, 43(Supplement 1), S183. https://doi.org/https://doi.org/10.2337/dc20-S014
5.
ArciniegaG. M.AndersonT.Tovar-BlankZ. G.TraceyT. J. G. (2008). Toward a fuller conception of Machismo: Development of a traditional Machismo and Caballerismo Scale. Journal of Counseling Psychology, 55(1), 19–33. https://doi.org/10.1037/0022-0167.55.1.19
6.
AshwellM.GunnP.GibsonS. (2012). Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis. Obesity Reviews, 13, 275–286. https://doi.org/10.1111/j.1467-789X.2011.00952.x
7.
AverillJ. B. (2002). Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qualitative Health Research, 12, 855–866. https://doi.org/10.1177/104973230201200611
8.
BaoW. E. Y.TobiasD.HuF. B.VaagA. A.ChavarroJ. E.MillsJ. L.GrunnetL. G.BowersK.LeyS. H.KielyM.OlsenS. F.ZhangC. (2015). Long-term risk of type 2 diabetes mellitus in relation to BMI and weight change among women with a history of gestational diabetes mellitus: A prospective cohort study. Diabetologia, 58, 1212–1219.
9.
BarnacleM.StrandM. A.WerremeyerA.MaackB.PetryN. (2016). Depression screening in diabetes care to improve outcomes: Are we meeting the challenge?The Diabetes Educator, 42, 646–651. https://doi.org/10.1177/0145721716662917
10.
BartonD. (2007). Literacy: An introduction to the ecology of written language. Wiley-Blackwell.
11.
CabanA.WalkerE. A.SanchezS.MeraM. S. (2008). “It feels like home when you eat rice and beans”: Perspectives of urban Latinos living with diabetes. Diabetes Spectrum, 21, 120–127. https://doi.org/10.2337/diaspect.21.2.120
12.
CanedoJ. R.MillerS. T.SchlundtD.FaddenM. K.SandersonM. (2018). Racial/ethnic disparities in diabetes quality of care: The role of healthcare access and socioeconomic status. Journal of Racial & Ethnic Health Disparities, 5, 7–14. https://doi.org/10.1007/s40615-016-0335-8
CastañedaS. F.GarciaM. L.Lopez-GurrolaM.StoutenbergM.EmoryK.DaviglusM. L.KaplanR.GiachelloA. L.MolinaK. M.PerreiraK. M.YoungbloodM. E.VidotD. C.TalaveraG. A. (2019). Alcohol use, acculturation and socioeconomic status among Hispanic/Latino men and women: The Hispanic Community Health Study/Study of Latinos. PLOS ONE, 14(4), e0214906. https://doi.org/10.1371/journal.pone.0214906
CherringtonA.AyalaG. X.ScarinciI.Corbie-SmithG. (2011). Developing a family-based diabetes program for Latino immigrants: Do men and women face the same barriers?Family & Community Health, 34, 280–290. https://doi.org/10.1097/FCH.0b013e31822b5359
Criado PerezC. (2019). Invisible women: Data bias in a world designed for men. Abrams Press.
19.
DenzinN.LincolnY. (2005). The Sage handbook of qualitative research. Sage.
20.
EverettB.SalamonsonY.DavidsonP. M. (2009). Bandura’s Exercise Self-Efficacy Scale: Validation in an Australian cardiac rehabilitation setting. International Journal of Nursing Studies, 46, 824–829. https://doi.org/10.1016/j.ijnurstu.2009.01.016
21.
FitzgeraldJ. T.AndersonR. M.FunnellM. M.HissR. G.HessG. E.DavisW. K.BarrP. A. (1998). The reliability and validity of a brief Diabetes Knowledge Test. Diabetes Care, 21(5), 706–710. https://doi.org/10.2337/diacare.21.5.706
22.
GallagherD.HeymsfieldS. B.HeoM.JebbS. A.MurgatroydP. R.SakamotoY. (2000). Healthy percentage body fat ranges: An approach for developing guidelines based on body mass index. The American Journal of Clinical Nutrition, 72, 694–701. http://www.ajcn.org/content/72/3/694.abstract
23.
GigerJ. N. (2016). Transcultural nursing assessment and intervention (7th ed.). Mosby Elsevier.
24.
GlynnS.RudermanA. (1986). The development and validation of an Eating Self-Efficacy Scale. Cognitive Therapy and Research, 10, 403–420. https://doi.org/10.1007/BF01173294
25.
GuariguataL.WhitingD. R.HambletonI.BeagleyJ.LinnenkampU.ShawJ. E. (2014). Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice, 103, 137–149. https://doi.org/10.1016/j.diabres.2013.11.002
26.
GuestG.MacQueenK. M. (Eds.). (2008). Handbook for team-based qualitative research. Altamira Press.
27.
HendricksonS. G.HarrisonT. C.LopezN. A.Zegarra-CoronadoA. G.RicksT. (2013). Translation cost, quality, and adequacy. Journal of Nursing Scholarship, 45, 185–191. https://doi.org/10.1111/jnu.12021
28.
HerediaN. I.FernandezM. E.DurandC. P.Kohl IiiH. W.RanjitN.van den BergA. E. (2020). Factors associated with use of recreational facilities and physical activity among low-income Latino adults. Journal of Immigrant & Minority Health, 22, 555–562. https://doi.org/10.1007/s10903-019-00920-7
29.
HuJ.AmirehsaniK. A.WallaceD. C.LetvakS. (2013). Perceptions of barriers in managing diabetes: Perspectives of Hispanic immigrant patients and family members. The Diabetes Educator, 39(4), 494–503. https://doi.org/10.1177/0145721713486200
30.
LarocheH. H.DavisM. M.FormanJ.PalmisanoG.ReisingerH. S.TannasC.SpencerM.HeislerM. (2009). Children’s roles in parents’ diabetes self-management. American Journal of Preventive Medicine, 37(6 Suppl 1), S251–S261. https://doi.org/10.1016/j.amepre.2009.08.003
31.
LeeJ. W.JonesP. S.MineyamaY.ZhangX. E. (2002). Cultural differences in responses to a Likert scale. Research in Nursing & Health, 25(4), 295–306. https://doi.org/doi:10.1002/nur.10041
32.
LeeS. Y.BenderD. E.RuizR. E.ChoY. I. (2006). Development of an easy-to-use Spanish Health Literacy Test. Health Services Research, 41, 1392–1412. https://doi.org/10.1111/j.1475-6773.2006.00532.x
33.
LoflandJ.SnowD.AndersonL.LoflandL. (2006). Analyzing social settings: A guide to qualitative observation and analysis (4th ed.). Wadsworth.
34.
LorigK. R.RitterP. L.JacquezA. (2005). Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes Educator, 31, 401–409. https://doi.org/10.1177/0145721705276574
35.
MalikF.SauderK.IsomS.RobertsA. J.Mayer-DavisE. J.DolanL.DabeleaD.LawrenceJ.PihokerC. (2020, June12-16). Trends in glycemic control among youth with diabetes: The search for diabetes in youth study. American Diabetes Association Scientific Sessions, Virtual Meeting.
36.
MansyurC. L.RustveldL. O.NashS. G.Jibaja-WeissM. L. (2015). Social factors and barriers to self-care adherence in Hispanic men and women with diabetes. Patient Education and Counseling, 98, 805–810. https://doi.org/10.1016/j.pec.2015.03.001
37.
MansyurC. L.RustveldL. O.NashS. G.Jibaja-WeissM. L. (2016). Hispanic acculturation and gender differences in support and self-efficacy for managing diabetes. Diabetes Educator, 42, 315–324. https://doi.org/10.1177/0145721716640905
38.
MarquezI.CalmanN.CrumpC. (2019, April). A framework for addressing diabetes-related disparities in US Latino populations. Journal of Community Health, 44, 412–422. https://doi.org/10.1007/s10900-018-0574-1
39.
Martinez-DonateA. P.ZhangX.RangelM. G.HovellM.SimonN. J.Amuedo-DorantesC.SipanC.GuendelmanS. (2014). Healthcare access among circular and undocumented Mexican migrants: Results from a pilot survey on the Mexico-US border. International Journal of Migration and Border Studies, 1, 57–108. https://doi.org/10.1504/ijmbs.2014.065069
40.
McCurleyJ. L.FortmannA. L.GutierrezA. P.GonzalezP.EuyoqueJ.ClarkT.PreciadoJ.AhmadA.Philis-TsimikasA.GalloL. C. (2017). Pilot test of a culturally appropriate diabetes prevention intervention for at-risk Latina Women. Diabetes Educator, 43, 631–640. https://doi.org/10.1177/0145721717738020
41.
MendenhallE.JacobsE. A. (2012). Interpersonal abuse and depression among Mexican Immigrant women with type 2 diabetes. Culture, Medicine and Psychiatry, 36, 136–153. https://doi.org/10.1007/s11013-011-9240-0
42.
MilesM.HubermanA. M. (1994). Qualitative data analysis. Sage.
43.
MontoyaJ.SalinasJ.BarrosoC.Mitchell-BennettL.ReiningerB. (2011). Nativity and nutritional behaviors in the Mexican origin population living in the US-Mexico border region. Journal of Immigrant and Minority Health, 13, 94–100. https://doi.org/10.1007/s10903-010-9342-8
44.
NuñezA.GonzálezP.TalaveraG. A.Sanchez-JohnsenL.RoeschS. C.DavisS. M.ArguellesW.WomackV. Y.OstrovskyN. W.OjedaL.PenedoF. J.GalloL. C. (2016). Machismo, marianismo, and negative cognitive-emotional factors: Findings from the Hispanic community health study/study of Latinos sociocultural ancillary study. Journal of Latina/o Psychology, 4(4), 202–217. https://doi.org/10.1037/lat0000050
PiccoloR. S.SubramanianS. V.PearceN.FlorezJ. C.McKinlayJ. B. (2016). Relative contributions of socioeconomic, local environmental, psychosocial, lifestyle/behavioral, biophysiological, and ancestral factors to racial/ethnic disparities in type 2 diabetes. Diabetes Care, 39, 1208–1217. https://doi.org/10.2337/dc15-2255
48.
Popovic-LipovacA.StrasserB. (2015). A review on changes in food habits among immigrant women and implications for health. Journal of Immigrant and Minority Health, 17, 582–590. https://doi.org/10.1007/s10903-013-9877-6
49.
PowersM. A.BardsleyJ. K.CypressM.FunnellM. M.HarmsD.Hess-FischlA.HooksB.IsaacsD.MandelE. D.MaryniukM. D.NortonA.RinkerJ.SiminerioL. M.UelmenS. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43, 1636–1649. https://doi.org/10.2337/dci20-0023
50.
RayanagoudarG.HashiA. A.ZamoraJ.KhanK. S.HitmanG. A.ThangaratinamS. (2016). Quantification of the type 2 diabetes risk in women with gestational diabetes: A systematic review and meta-analysis of 95,750 women. Diabetologia, 59, 1403–1411. https://doi.org/10.1007/s00125-016-3927-2
51.
RoslandA. M.HeislerM.ChoiH. J.SilveiraM. J.PietteJ. D. (2010). Family influences on self-management among functionally independent adults with diabetes or heart failure: Do family members hinder as much as they help?Chronic Illness, 6, 22–33. https://doi.org/10.1177/1742395309354608
SaeediP.PetershnI.SalpeaP.MalandaB.KarurangaS.UnwinN.ColaguiriS.GuariguataL.MotalaA.OgurtsovaK.ShawJ.BrightD.WilliamsR. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice, 157, 1–10. https://doi.org/10.1016/j.diabres.2019.107843
54.
SafieddineB.SperlichS.BellerJ.LangeK.EppingJ.TetzlaffJ.TetzlaffF.GeyerS. (2020). Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners. SSM Population Health, 11. https://doi.org/10.1016/j.ssmph.2020.100596
55.
SodhiN. K.NelsonA. L. (2018). Prevalence of glucose intolerance and metabolic syndrome within one year following delivery of a pregnancy complicated by gestational diabetes. Contraception & Reproductive Medicine, 3, 27. https://doi.org/10.1186/s40834-018-0080-y
56.
SofianouA.FungT.TuckerK. L. (2011). Differences in diet pattern adherence by nativity and duration of US residence in the Mexican-American population. Journal of the American Dietetic Association, 111, 1563–1569, e1562. https://doi.org/10.1016/j.jada.2011.07.005
57.
Smith-MillerC. A.BerryD. C.MillerC. T. (2017). Diabetes affects everything: Type 2 diabetes self-management among Spanish-speaking hispanic immigrants. Research in Nursing & Health, 40, 541–554. https://doi.org/10.1002/nur.21817
StrandM. A.WarneD. (2014). The diabetes, depression, and alcohol triad: Potential impact on community development. International Journal of Social Ecology and Sustainable Development, 5, 31–46. https://doi.org/10.4018/ijsesd.2014010104
60.
SweattS. K.WilligA. L.AgneA. A.PowellJ. L.CherringtonA. L. (2015). Physical activity patterns of Latina immigrants living in Alabama. Journal of Racial & Ethnic Health Disparities, 2, 365–372. https://doi.org/10.1007/s40615-015-0083-1
61.
WalkerS. N.KerrM. J.PenderN. J.SechristK. R. (1990). A Spanish language version of the Health-Promoting Lifestyle Profile. Nursing Research, 39, 268–273. https://doi.org/10.1097/00006199-199009000-00003
ZunL. S.SadounT.DowneyL. (2006). English-language competency of self-declared English-speaking Hispanic patients using written tests of health literacy. Journal of the National Medical Association, 98, 912–917.
