Diabetes Causation Beliefs among Latinos with Type 2 Diabetes: “That's the key to a little bit of understanding between the doctor and the patient”

Background: In the U.S., Latinos have a higher prevalence (12-19%) of type 2 diabetes and poorer diabetes outcomes relative to whites (8%). Successfully managing diabetes is complex and may be difficult for this group because they generally have fewer economic resources and less access to health promoting environments. Latinos also face various toxic socioeconomic stressors that can act as barriers for diabetes self-care activities. Stress as it relates to diabetes, is important to address particularly because within Latino culture there is a traditional belief that stress or strong emotions (i.e., susto) causes the onset of diabetes and influences its management. Rationale: Given this historical and cultural belief, the purpose of this study is to: a) describe how susto is understood among Latino patients with type 2 diabetes and b) discuss how diabetes causation beliefs influence diabetes management. Methods:  Patients’ diabetes causation beliefs were quantitatively assessed using the Illness Perception Questionnaire-Revised (IPQ-R) and qualitatively assessed via focus group discussions. The IPQ-R includes a list of 20 diabetes causation items and patients were asked to endorse whether they agreed or disagreed with the item. Two semi-structured focus groups were conducted with 13 Latino patients with type 2 diabetes. Results: The top three endorsed diabetes causation items included: 1) Stress and Worry, 2) My own Behaviors, and 3) Hereditary-it runs in my family. The qualitative results demonstrated that the majority participants believe that diabetes is caused by susto and also referred to this concept as coraje (i.e., anger). “My uncle was afraid because of what he saw…it’s like fear, more like because of susto he fell in coma or shock. When they took him to the hospital they cured his shock and 15 days later they diagnosed him with sugar”. Stress was described as a result of experiencing busy and fast paced work environments, “The pressure from work … every day to survive….I struggle with my stress, my illness, and all of that”. Participants also believed that diabetes was inherited or caused by an unhealthy diet, “it came from heredity or because of the food and the stress”. Understanding a patient’s health belief was perceived as an important factor for treating and managing the disease, “it helps the doctor to better understand the person he's dealing with”, “That's the key to a little bit of understanding between the doctor and the patient”, “if the patient does answer it was the stress…or diet they could be helped”. Diabetes orientation programs for families and support groups were other primary theme that emerged. Conclusion:  Stress was identified as a cause of diabetes in addition to several behavioral and hereditary factors. Asking Latinos with diabetes about health beliefs could help prioritize treatment and management goals.