Introduction
Cultural Influences andAttitudes Towards Chronic Conditions in HispanicAmericans
Emilia Rouse, Dr. Martine Hackett PhD Department of Health Science. Hofstra University, Hempstead, New York 11549
Discussion
The purpose of this study is to understand the way cultural influences affect Hispanic people‘s response to the diagnosis and treatment of chronic diseases. Chronic diseases are ailments that affect a person for their whole life. Some of the more well-known ones include diabetes, hypertension, and high cholesterol. As people age, their likelihood for chronic diseases increases and many have multiple chronic conditions (MCC).A 2024 study found that 20% of people have MCC yet they make up 60% of US healthcare costs1
LatinAmericans have a heightened prevalence of diabetes of around 17% across all age groups2 There has been an upward trend in the prevalence of Type 2 diabetes and, if it continues, by 2038 an estimated 40% of Latin Americans 55 years old and older will have type 2 diabetes3. Another reason why specifically LatinAmericans are the focal point of this study is because studies have shown that “Latinos with diabetes mellitus and related conditions have more frequent complications and hospitalizations, greater functional impairment, lower quality of life, and higher mortality rates when compared to non-Latino whites4.” It is imperative to address this gap in the healthcare system.
In terms of treatment, Latin Americans are lagging behind other populations. Management along the border and across is incredibly varied, with one study finding that less than a quarter met conditions set by their doctor1. There is very little trust in the medical system as many immigrants are reported to go to “curanderos” (folk doctors) instead of relying on the medical system before their conditions escalates5. Additionally, many HispanicAmericans expressed strong senses of nihilism and psychological distress over their diagnoses at significantly higher rates than non-HispanicAmericans2,5 . These negative attitudes towards treatment and the prospect of getting better hinders Hispanic-Americans and Hispanic immigrants from seeking treatment until their condition progresses to dangerous levels. To understand and combat this phenomenon, this study aims to discover the cultural influences affecting these attitudes towards chronic diseases and their management.
Preliminary Work
Formulated Research Question Created Interview Questions
Participant Interviews
Transcribed Interviews Translated Quotes of Interest Created Interview Codebook
Data Analysis
Utilized ChatGPT to refine codes
Synthesized codes into themes Formulated Conclusions
Results
The major themes were found to be the following:
Participants frequently felt that their chronic conditions were ultimately inevitable and incurable. These attitudes referred to the chronic nature of their conditions and the equally chronic management. Many expressed little hope in long-term management.
“Diabetes has no cure. Yeah, you can control it, but, in the end, it is the end”
“When you’re as old as I am, I already- I already-, if this doesn’t kill me, something else will, and that’s how I took [the diagnosis]”
Many discussed their diagnosis having strong social affects on their lives. Many felt as though they were no longer recognizable to their friends and family.Additionally, the participants themselves felt their lives as they knew it were forever altered after their diagnoses.
“It’s already… they no longer live as the same, normal people”
“The disease of high blood pressure – you stop living a life”
The participants also consistently felt negatively about prescription medication. Particularly, participants were reluctant to rely on prescription medication and felt it was a personal affront to need it.
“That’s always how it goes, they live below the medicine”
From the themes gathered in the interviews, further analysis was carried out to better understand the importance and origin of these themes.
Across the interviews, there was a running thread of Fatalism. There was a prevailing sense that, at the end of the day, their condition was inevitable. Some interviews had them come from watching other family members with similar conditions and others this sense came from how their physicians described their condition. Underpinning both of these explanations, however, is the cultural expectation that all that occurs is predestined.Across the subjects interviewed, there was a resignation that the chronic condition meant treatment was only borrowing time. Interestingly, this did not apply to lifestyle changes but immediately applied to medication. Aphysician working with these populations needs to carefully consider how they word diagnosing chronic conditions as well as treatment options.
Community is prized value of Hispanic cultures. When asked how friends, family, and other community members reacted to the news of the diagnosis, there were a variety of responses. Shock, disbelief, support, and a vast array of emotions were all discussed. However, there was a consistent sensation that they became fundamentally different to their community. Once diagnosed, the interviewees felt they ceased to be normal and became an other to their social circles. Often, this meant they were regarded with an increased amount of fragility and sometimes isolation. Losing their standard interactions with the community was disheartening for all and lead many to hide their conditions and symptoms amongst friends and family. Without support, treating and managing chronic conditions is significantly more difficult.
There was a prevailing sense amongst the interviewees that relying on medication was inherently negative. There were different senses across the interviewees as to why. Some viewed taking daily medication as a form of dependence. One specifically likened it to an addict’s dependence on substances. Others saw taking daily medication as a sign that they couldn’t handle their condition alone or naturally. It often felt as though medication was a weakness to the subjects. Needing medication was seen across the board as a serious moral failing among participants. Those who did not need it regularly made sure to bring that up to the investigator and the two the relied on it mentioned that they were working towards making lifestyle changes to need it less consistently. Physicians must ensure that when presenting prescription medication to this population that they affirm that taking medication is not a personal reflection on the patient.
Conclusion
Fatalism, feeling othered, and disillusion with medication were the core themes of this study. Together, these themes represent a deep fear that having a chronic condition is failing of the person themselves. It may be why many of participants felt as though their condition was inevitable. Additionally, as their social circle begins to distance themselves or treat the participants with excessive amounts of pity, they begin to feel as though they have done something wrong. Lastly, the resistance towards prescription medication may stem from a desire to regain autonomy. There is a strong emotional tie to their conditions.
A point of interest should be whether or not these attitudes are persisting in the younger generations of HispanicAmericans. Cultures are always evolving and it’s important that physicians and health professionals stay on top of the changes and shifts of cultures among their patient population.
Most participants in this study were part of the Cornell Cooperative Exchange’s program, FreshRX; thus, this was not a random sample and cannot be extrapolated onto all Hispanic Americans.Additionally, the sample size was quite small. Both of these factors served as limits for this study.
Sources
1. Lopez, J., Z., Lee, M., Park, S., K., Zolezzi, M., E., Mitchell-Bennet, L. A., Yeh, P. G., Perez, L., Heredia, N., I., McPherson, D., D., McCormick, J. B., Reininger, B., M. An expanded chronic care management approach to multiple chronic conditions in Hispanics using community health workers as community extenders in the Rio Grande Valley of Texas. Preventative Medicine. 2024; 184. https://doi.org/10.1016/j.ypmed.2024.107975
2. Castaneda, S., F., Gallo, L., C., Garcia, M., L., Mendoza, P., M., Gutierrez, A., P., Gurrola, M. Effectiveness of an integrated primary care intervention in improving psychosocial outcomes among Latino adults with diabetes: the LUNA-D study. Translational Behavioral Medicine. 2022; 12 (8): 825+. http://dx.doi.org.ezproxy.hofstra.edu/10.1093/tbm/ibac042
3. Ro,A., Van Hook, J., Walsemann, K., M. Undocumented Older Latino Immigrants in the United States: Population Projects and Share of Older Undocumented Latinos by Health Insurance Coverage and Chronic Health Conditions, 20182028. The Journals of Gerontology. 2022; 77 (2): 389 - 395. https://doi-org.ezproxy.hofstra.edu/10.1093/geronb/gbab189
4. Gallo, L.C., Fortmann,A.L., Bravin, J.I., Clark, T.L., Savin, K.L., Ledesma, D.L. My Bridge (Mi Puente), a care transition intervention for Hispanics/Latinos with multimorbidity and behavioral health concerns: protocol for a randomized controlled trial. Trials. 2020; 21 (1). doi: https://doi.org/10.1186/s13063-019-3722-8
5. Provencio, S., J.S. Latinx immigrant experiences with chronic illness management in Central Texas: reframing agency and liminality through nepantla Anthropol Med. 2022;29(4):367-382. doi:10.1080/13648470.2022.2144803.
Methods
Demographics
Further Research Limitations
Theme #1 - Fatalism
Theme #2 – Feeling Othered
Theme #3 – Disillusion with Medication