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.
AschnerP.Obesity in Latin America. In: AhimaRS (ed.) Metabolic syndrome.
Cham:
Springer International Publishing, 2016, pp.33–39.
2.
Bello-ChavollaOYAguilar-SalinasCA.Diabetes in Latin America. In: Dagogo-JackS (ed) Diabetes mellitus in developing countries and underserved communities.
Cham:
Springer International Publishing, 2017, pp.101–126.
3.
BrowneJLVenturaADMoselyK, et al.
Measuring the stigma surrounding type 2 diabetes: Development and validation of the Type 2 Diabetes Stigma Assessment Scale (DSAS-2). Diabetes Care2016;
39: 2141–2148.
4.
Young-HymanDde GrootMHill-BriggsF, et al.
Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care2016;
39: 2126–2140.
5.
Schmidt-BusbyJWilesJExeterD, et al.
Understanding “context” in the self-management of type 2 diabetes with comorbidities: A systematic review and realist evaluation. Diabetes Res Clin Pract2018;
142: 321–334.
6.
WallaceDDGonzalez RodriguezHWalkerE, et al.
Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic. Glob Public Health2018;
14(1): 1–12.
7.
Owens-GaryMDZhangXJawandaS, et al.
The importance of addressing depression and diabetes distress in adults with type 2 diabetes. J Gen Intern Med2018;
Oct 22: 1–5.
8.
GonzalezJSKaneNSBinkoDH, et al.
Tangled up in blue: Unraveling the links between emotional distress and treatment adherence in type 2 diabetes. Diabetes Care2016;
39: 2182–2189.
9.
FisherLGlasgowREStryckerLA.The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. Diabetes Care2010;
33: 1034–1036.
10.
DuangdaoKMRoeschSC.Coping with diabetes in adulthood: A meta-analysis. J Behav Med2008;
31: 291–300.
Gonzalez RodriguezHWallaceDDBarringtonC.Contextualizing experiences of diabetes-related stress in rural Dominican Republic. Qual Health Res2019;
29(6): 857–867.
13.
SandelowskiM.Focus on qualitative methods qualitative analysis: What it is and how to begin. Res Nurs Health1995;
18: 371–375.
14.
MilesMBHubermanAM. Matrix displays: Some rules of thumb. In: Qualitative data analysis: An expanded sourcebook. Newcastle upon Tyne: Sage, 1994, pp.239–244.
15.
SaldañaJ. Writing analytic memos. In: The coding manual for qualitative researchers. Newcastle upon Tyne: Sage, 2009, pp.32–44.
16.
KentDHaasLRandalD, et al.
Healthy coping: Issues and implications in diabetes education and care. Popul Health Manag2010;
13: 227–233.
17.
DarvyriPChristodoulakisSGalanakisM, et al.
On the role of spirituality and religiosity in type 2 diabetes mellitus management—A systematic review. Psych2018;
9: 728–744.
18.
WhitmarshI.The ascetic subject of compliance: The turn to chronic diseases in global health. In: BiehlJAdrianaA (eds) When people come first: Critical studies in global health.
Princeton:
Princeton University Press, 2013, pp.302–324.
19.
BrundisiniFVanstoneMHulanD, et al.
Type 2 diabetes patients’ and providers' differing perspectives on medication nonadherence: A qualitative meta-synthesis. BMC Health Serv Res2015;
15: 516.
20.
SchwartzDDStewartSDAikensJE, et al.
Seeing the person, not the illness: Promoting diabetes medication adherence through patient-centered collaboration. Clin Diabetes2017;
35: 35–42.
21.
WardianJSunF.Factors associated with diabetes-related distress: Implications for diabetes self-management. Soc Work Health Care2014;
53: 364–381.
22.
BrowneJLVenturaAMoselyK, et al. ‘
I call it the blame and shame disease ’: A qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open2013;
3: e003384.
23.
AikinsAD-G.Reframing applied disease stigma research: A multilevel analysis of diabetes stigma in Ghana. J Community Appl Soc Psychol2006;
16: 426–441.
24.
Kabat-ZinnJ.Full catastrophe living (revised edition): Using the wisdom of your body and mind to face stress, pain, and illness. Revised ed. New York: Random House Publishing Group, 2013.
25.
WhitebirdRRKreitzerMJO’ConnorPJ.Mindfulness-based stress reduction and diabetes. Diabetes Spectrum2009;
22: 226–230.
26.
TovoteKAFleerJSnippeE, et al.
Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: Results of a randomized controlled trial. Diabetes Care2014;
37: 2427–2434.
27.
Ortiz JA. Bridging the gap: Adapting mindfulness-based stress reduction for Latino Populations (Doctoral dissertation). 2015. Retrieved from UNM Department of Psychology Digital Repository. https://digitalrepository.unm.edu/psy_etds/107
28.
Rosario AcostaY. A feasibility and acceptability study of the Spanish version of mindfulness based stress reduction (Doctoral dissertation). 2016 Alliant International University, ProQuest Dissertations Publishing. https://search.proquest.com/docview/1851276238?pq-origsite=gscholar
29.
WhitebirdRRKreitzerMJVazquez-BenitezG, et al.
Reducing diabetes distress and improving self-management with mindfulness. Soc Work Health Care2018;
57: 48–65.
30.
TranANOrnelasIJKimM, et al.
Results from a pilot promotora program to reduce depression and stress among immigrant Latinas. Health Promot Pract2014;
May15: 365–372.
31.
PriyaGKalraS.Mind-body interactions and mindfulness meditation in diabetes. Eur Endocrinol2018;
14: 35–41.
32.
ChaiopanontS.Hypoglycemic effect of sitting breathing meditation exercise on type 2 diabetes at Wat Khae Nok Primary Health Center in Nonthaburi province. J Med Assoc Thai2008;
91(1): 93–98.
