Wellness iNPractice Diabetes

Building Cultural Competence in Caring for Latino Patients with Diabetes

Understanding how the social and cultural backgrounds of your patients may influence aspects of diabetes management can help you and your patients craft a self-care plan that is more likely to succeed and get patients to their treatment goals. Cultural competence in health care has been defined as the capacity to provide effective medical care to persons of varied backgrounds through the use of appropriate knowledge, skills, attitudes, and behaviors.1,2 Cultural competence among healthcare providers can help strengthen lines of communication between the clinician and the patient, allowing patient preferences to be heard, respected, and incorporated into the plan of care through shared decision-making.

Certain cultural practices or beliefs may conflict with what patients are being asked to do to manage diabetes. For example, the types of foods that are recommended for controlling blood glucose may be different from what patients traditionally eat, and patients may find it difficult to incorporate certain dietary changes into their lives. Historical mistrust in the healthcare system, perceptions about a diagnosis or its impact on lifestyle, and belief in the effectiveness of treatment can also influence adherence to self-care plans.1

Multiple medical, social, and cultural influences can add to the complexity of identifying and treating diabetes in Latino patients. While not all people from a certain culture will respond the same way to a diagnosis of diabetes or the requirements of diabetes self-care, there are a few common themes that have been reported in the literature that relate Latino culture to self-care behaviors3,4:

  • Hispanics/Latinos tend to stress the importance of personal rather than institutional relationships, and may rely on community-based organizations for health education and care 
  • Hispanic/Latino patients may expect quick relief from symptoms 
  • Hispanic/Latino patients may regard American medications with caution, and may prefer to use herbal treatments 
  • Some Hispanic/Latino patients might be reluctant to speak up about their illness 
  • Due to misplaced deference or reluctance to share deeply personal information, Hispanic/Latino patients may minimize or conceal adverse events—or even stop taking medications—without telling the healthcare professional 
  • Family members may be involved in making healthcare decisions for the family, particularly the mother or grandmother
  • Hispanic patients may believe an absence of symptoms means that they are cured
  • − When symptoms stop, they may not adhere to their drug regimens
    − This could especially be a problem in treating diabetes
  • Latin Americans expect injections, and so may believe that oral medicine is not as effective 
  • Mexican and Puerto Rican patients may worry about a drug’s addictive potential, which can make them reluctant to take the drug over the long term

A recent survey of Nurse Practitioners found that they directly contribute to cultural competence in patient care by establishing partnerships with their patients that account for cultural factors and adjusting care to meet individual patient needs in a cultural context.5

The ability to conduct a cultural assessment is an essential skill that can help you and your patients develop a culturally relevant treatment plan. There are several frameworks that have been developed to help nurses conduct a cultural assessment.6 In one model, the nurse first invites the patient to explain their perceptions—physiological, psychological, spiritual, and/or cultural—about diabetes or a certain aspect of its treatment and then the nurse shares his or her perception of the same topic. The next step involves identifying any cultural differences and then finding any similarities that treatment can be built on. Treatment recommendations are then negotiated, incorporating selected aspects of the patient’s culture into the diabetes self-care plan.

A cultural assessment can be integrated into a larger discussion about diabetes treatment, using the Patient Interview Guide

You can find more information about providing culturally competent diabetes care to your patients at the National Diabetes Education Program Website.

References

  1. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports. 2003;118(4):293-302.
  2. Clarke ME, DeGannes CN. Cultural competency in healthcare: a clinical review and video vignettes from the National Medical Association. http://www.medscape.com/viewprogram/12540. Accessed September 30, 2015. 
  3. The National Alliance for Hispanic Health. A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics. http://www.hispanichealth.arizona.edu/Primer%20for%20Culural%20Proficiency%20NAHH.pdf. Accessed September 30, 2015. 
  4. Hatcher E, Whittemore R. Hispanic adults' beliefs about type 2 diabetes: clinical implications. J Am Acad Nurse Pract. 2007;19(10):536-545. 
  5. Matteliano MA, Street D. Nurse practitioners' contributions to cultural competence in primary care settings. J Am Acad Nurse Pract. 2012;24(7):425-435. 
  6. Campinha-Bacote J. Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online J Issues Nurs. 2011;16(2):5.