Understanding Health Care Management Behaviors Among African-American and Latino Men with Diabetes in a Diabetes Lifestyle Intervention

BACKGROUND: Among men nationally, Type 2 diabetes is more prevalent in African American and Latino men compared to non-Hispanic White men. Due to gender and cultural differences in socialization and lifestyle practices, including beliefs related to masculinity, African American and Latino men are more likely to adopt diabetes self-care and health seeking behaviors that may undermine successful disease management. The purpose of this study was to explore and understand the contextual factors that influence diabetes self-care and health care use among men participating in a Community Health Worker (CHW)-led diabetes lifestyle intervention.

METHODS: Qualitative data were collected from one focus group with African American men (n=9) and two focus groups with Latino men (n=13). Focus groups with Latino men were held in Spanish. Sessions lasted 90 minutes, were audio-taped, transcribed verbatim, and analyzed using thematic content analysis techniques. Focus groups were conducted in public venues in a major city in the Midwest.

RESULTS: Three themes emerged that focused on factors that served as motivators or barriers to diabetes self-care behaviors and health seeking among men in the intervention: (i) traditional beliefs about masculinity: Participants stated that community norms of manhood suggest that men must endure pain, resulting in delayed reports of symptoms and avoidance of visits to health care providers; (ii) relationships with CHWs, significant others and immediate family members: Participants also stated that the social support provided by CHWs, particularly information relating to diet and managing medication regimens, played a pivotal role in improving their overall health. Men also reported that support from significant others and immediate family members could play both a positive and negative role, depending on willingness to be active participants in their diabetes care; (iii) resource availability: Participants reported that lack of health insurance resulted in delayed health seeking and limited access to resources related to diabetes care, which negatively impacted their ability to manage their health.

CONCLUSIONS: This study identified determinants of diabetes self-care and health seeking in  African American and Latino men with diabetes participating in a diabetes health-management intervention. The socialization of men and masculinity, relationships with health care providers and family, and access to resources may be significant factors in decisions to engage in diabetes self-care and health care utilization. Further research is needed to examine the determinants of self-care and health seeking behaviors in African-American and Latino men with diabetes, in particular the influence of interpersonal relationships and the role of masculinity. Results can be used to develop programs specifically targeting African-American and Latino men with diabetes.