By Jordan Royster, Undergraduate Student, College of Public Health, The Ohio State University
In the United States, Spanish speaking persons have a higher risk of being diagnosed with type 2 diabetes mellitus1. Previous studies have examined health outcomes in relation to familismo on Spanish-speaking diabetic patients. However, the research did not determine the interplay of disease management and cultural values. Familismo is a cultural value, that emphasizes the needs of one’s nuclear or extended family over one’s personal needs. This project focused on the process of familismo and the effects of trans-lingual interactions on the patient’s management of diabetes.
All participants were Type II diabetic patients and family members living in the same household. The families had two to five members and everyone spoke Spanish. Four families from Columbus, Toledo, Lorain, and Cincinnati Ohio, were interviewed in March 2018. The cities were chosen because of their varied population sizes. In 2016, Columbus had the largest population of 860,090, then Cincinnati with 298,800, Toledo with 278,508 and Lorain with 63,7302.
The interviews, which lasted approximately one hour, were round table discussions with the patients and family members. The written questions were shared with everyone and each patient and family member was given an opportunity to address every question. The same researcher conducted the interviews and took handwritten notes of the discussions. A content analysis was done on the themes of the interview.
The objectives of the interviews were to determine the following:
- The family’s perception of messages deployed by bilingual members through language brokering, the interpretation and translation of concepts to patients with different cultural and linguistic backgrounds3.
- The factors that determine which family member serves as the primary support for the diabetic patient.
- Changes in the family’s health behavior after the patient’s diabetes diagnosis.
With two of the families, an adult child with advanced English skills attended the doctor appointments with the patients. They served as patient advocates, ensuring that the diagnosis and recommended changes were understood and carried out by the patient. The other two families only had the patient attend the doctor appointments because one family’s children lived in Mexico and the other family had young children. However, both patients mentioned their husband and one patient’s extended family served as a strong support network for when she was home. For all the families the main support was a family member. Three of the families indicated their spouses as the primary support, although none of the spouses attended the doctor appointments. Two of these families then mentioned additional family members, children and an aunt that also support them through the management of diabetes. One patient relied on her adult daughter who was also suffering health complications.
In regard to lifestyle changes, two families shifted their diets to encompass the dietary constraints of diabetes, such as by eating less processed food and fats. For the Toledo family, the patient drastically changed her diet and her daughter also adopted healthier eating habits. Although other family members have resisted most dietary changes, efforts to improve their eating habits continue. The Lorain patient changed her diet and the family reduced unhealthy available foods in the home. To varying degrees, the members of all four families were involved in the diabetes management of the patients.
Within the Spanish speaking community, sharing food and meals is an important component of the familial relationship. Having one member not able to participate in this cultural practice can be isolating4&5. Medical professionals should be aware of the family’s dietary practices to best help the patient achieve lifestyle changes that are most effective.
The Global Mobility Grant helped fund the travel expenses as well as compensate the families for their time in participating in this project.
- CDC Features. (2017, September 18). Retrieved March 26, 2018, from https://www.cdc.gov/features/hispanichealth/index.html
- QuickFacts. (n.d.). Retrieved March 25, 2018, from https://www.census.gov/quickfacts/fact/table/loraincityohio,cincinnaticityohio,toledocityohio,columbuscityohio/PST045217
- Dorner, L. M., Orellana, M. F., & Jiménez, R. (2008). It’s One of Those Things That You Do to Help the Family. Journal of Adolescent Research, 23(5), 515-543. Retrieved from https://doi.org/10.1177/0743558408317563.
- Devine, Carol M. et al. (1999, March). Food Choices in Three Ethnic Groups: Interactions of Ideals, Identities, and Roles. Journal of Nutrition Education, Volume 31, Issue 2, 86 – 93. DOI: https://doi.org/10.1016/S0022-3182(99)70400-0
- Kulkarni, K. D. (2004, October 01). Food, Culture, and Diabetes in the United States. Retrieved March 28, 2018, from http://clinical.diabetesjournals.org/content/22/4/190.short