It should also be noted that the natural evolution of type 2 diabetes is such that it may progress and remain uncontrolled despite a patient’s best efforts to follow medical advice.55 In this context, our findings suggest that many patients who try alternative therapies may be highly motivated to control their diabetes and engaged in an earnest effort to try all methods available to them. The patients we interviewed were not passively relying solely on alternative treatments but instead pursued several treatment strategies simultaneously.
Furthermore, there is some evidence of the clinical efficacy of the 2 herbs most commonly mentioned by these patients. In laboratory studies, both nopal and nispero have been found to have notable hypoglycemic effects. Studies of both patients with diabetes and of laboratory animals with induced hyperglycemia have reported that these substances decrease serum glucose levels from 17% to 46%.56-62 Although this research area is not well developed, it is possible that these herbs do in fact help reduce glucose levels.
We also found that the role of religion in the management of these patients’ diabetes was not in opposition to their medical treatment but very much in its support. Patients who use prayer and religion to help with illness management are often portrayed in the medical literature as fatalistic, abdicating responsibility for their health care to a higher power, and failing to take care of themselves. Although many of our participants said God is important in controlling their diabetes, they felt God works through the clinician and medications, not in place of them.
Limitations
Our study was designed with the goal of developing a thorough understanding of the treatment concepts and practices of the participants. It was not designed to produce generalizable findings. Our findings should not be taken to refer to a broader population but should be viewed as a window on how a group of individuals think about and use these treatment systems. We have chosen to note percentages in reporting our findings to show the distribution of a concept or behavior within our study group. This should not be taken to imply an expected prevalence in a larger population.
It also must be emphasized that these are tentative findings. They are based on a relatively small convenience sample drawn from patients already receiving clinical care or participating in education intervention trials. We have sampled particularly motivated patients, all of whom were active in treatment. This study group is biasedtoward those who embrace biomedical approaches and does not address the alternative treatment behavior of those who do not. Further research with less motivated patients who are irregular users of clinical services might give us different insights into the prevalence and role of these treatments. Still, our findings raise some important challenges to conventional wisdom in the medical literature regarding the role of traditional health beliefs among Mexican American patients.
Conclusions
In focusing on the alternative treatment beliefs and practices of a group of low-income, low-educational level Mexican Americans, this study challenges some common assumptions about the role of traditional attitudes and health beliefs in their care of type 2 diabetes. Further studies involving a community-based randomized sample including persons not already in clinical care would be necessary to determine if our findings can be generalized to a broader population. Still, at least among those we interviewed, alternative therapies did not present important barriers to medical management of the illness. These findings indicate that patients’ references to alternative treatment or God’s intervention should not instantly label them of fatalistic or noncompliant. Instead, careful consideration of how individuals actually use and evaluate alternative therapies is indicated, to help us better understand how important those treatments might be to these patients and how their use actually affects implementation of prescribed regimens.
Acknowledgments
This research was supported by grants from the South texas Research Center, University of Texas Health Science Center as San Antonio (UTHSCSA) and from the Agency for Health Care Policy and Research, Grant #1-UO1-HSO7397 to the Mexican American Medical Treatment Effectiveness Research Center at UTHSCSA. Interviews were conducted by DeAnn Pendry, Miguel Valenzuela, Armando Cortez, and Linda Hunt. Miguel Valenzuela, Armando Cortez, and Ricardo Montez helped with data analysis. We wish to thank Dr Laura Lein of the Department of Anthropology, University of Texas, Austin, and D. Jacqueline Pugh of the Department of Medicine. University of Texas Health Science Center at San Antonio, for their involvement in our research project. We also wish to thank Robert Wood for his help with statistical analysis. The Institutional Review Board of the University of Texas Health Science Center at San Antonio approved our study. Informed consent was obtained from all participants, and measures have been taken to assure their privacy and anonymity.