Making the Most of Familismo to Curb the Diabetes Epidemic: Early Evidence of Success Delivering the Same Intervention to Latinas at Risk for and With Diabetes.

ABSTRACT

Background/objectives: In the USA, diabetes disproportionately affects Hispanics/Latinx, continuing to contribute to health disparities. To address the diabetes epidemic, separate programs for pre-diabetes and diabetes are promoted nationwide. However, engagement by Hispanics/Latinx in either program is lagging. Recent evidence suggests that offering a single community health worker delivered intervention that includes both groups and allows family members to participate may be more effective and in harmony with Latino cultural values, especially if offered to Latino women (Latinas) who traditionally are in charge of food preparation. Our objective was to explore the results of an intervention delivered to low-income Latinas at various dysglycemic levels (diabetic and pre-diabetic). Methods: In this quasi-experimental mixed-methods cohort study we longitudinally assessed biometric outcomes and health behaviors among obese Latinas at risk for-and with-diabetes, participating in the same intervention. Data were collected at baseline and 3 months post-intervention. Focus group discussions and interviews provided qualitative data to help contextualize findings. Results: Participants at different levels of the dysglycemic spectrum benefited equally from the intervention across most measures. Among participants whose relatives had diabetes, weight loss exceeded that of participants without diagnosed relatives. Domestic partners' support, attending the program in a group setting, and previous diagnoses from a healthcare professional were associated with better results. Conclusions: Our findings indicate that a community health worker-delivered intervention for Hispanics/Latinx with-and at-risk for-diabetes is feasible and could be more effective in reducing Hispanics/Latinx' diabetes burden. Health educators and clinicians should consider tapping into the collective nature of the Latinx/Hispanic culture to encourage healthy behaviors among individuals whose family members have diabetes, regardless of their dysglycemic status. We recommend replicating this study with a more rigorous randomized design, a larger number of participants and longer-term follow-up.

ABSTRACT

METHODS: In this study, participants were Latino women (Latinas) from Southern California who either had diabetes or were on the path to having diabetes because of their weight or lab results. They all enrolled in a program where community health workers encouraged them to eat better and to exercise. We checked weight, labs and behaviors before and after the program and interviewed some after they completed it. RESULTS: all benefited from the program. But those whose relatives had diabetes, those whose doctors told them they had prediabetes/diabetes, and those attending in groups did better. CONCLUSION: using the proposed family-based approach among Latinos may lead to better diabetes prevention and management in clinical settings.

Encouraging similar habits around eating for all family members - whether at risk of or with diabetes - is in keeping with one of the key latino values putting family first. Preliminary results point to more success for everyone when a "family first" strategy - instead of promoting individual treatment plans - is applied among latinas with diabetes or at risk of developing diabetes In the USA, Latinos are among the groups with the highest rates of obesity and diabetes. People with obesity often have diabetes too. We know that, when a person in the family has diabetes, almost always other family members will be on the path to developing diabetes, if they do not yet have it. We also know that exercise and healthy eating habits can help prevent and control diabetes. In the USA, instead of offering the entire family (those on their way to diabetes and those with diabetes) the same program - "eat healthier and exercise" - there are separate programs or options based on each diagnosis a program for those with diabetes, a program for those who qualify as having prediabetes, and no program for those who do not qualify but are on their way to having pre-diabetes due to obesity. Offered programs have not been successful among Latinos for several reasons in part because they just don't attend as many classes as other groups. For Latinos, family - and specially having mealtimes together - is extremely important ("familismo" concept). This is even more critical for women preparing meals for their families. Separate diets and mealtimes goes against, and may sometimes interfere with, that sense of unity.