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Structure, Socialization and Agency in Diabetes Prevention Behaviors among Latinxs: A Mixed-Methods Study
Formagini Farag, Taynara NMN
Formagini Farag, Taynara NMN
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Abstract
Introduction: Latinxs living in the United States face persistent social injustices and health disparities, including in the prevention and management of diabetes. The high burden of diabetes among Latinxs has a detrimental impact on population health. However, type 2 diabetes can be prevented. The Diabetes Prevention Program (DPP) demonstrated that a modest body weight loss from consumption of a healthy diet and regular engagement in physical activity can prevent or delay diabetes. However, the program is only working modestly among Latinxs. There is a critical need to improve DPP reach, feasibility, and effectiveness for this group. While it is known that the interaction of individual factors with economic and social factors, including acculturation, impacts the pursuit of health behaviors among Latinxs, gaps about how these factors interact with each other in supporting or discouraging a continuing engagement in these behaviors remain.Objectives: I explored how the interaction of individual, social, and economic processes are associated with engagement and maintenance of diabetes prevention behaviors among Latinxs. In aim one and aim two, I assessed how diet quality, physical activity engagement, and prediabetes status varied among Latinx subgroups according to socioeconomic status and acculturation levels. In aim three, I explored the interplay between structure, socialization, and agency in shaping diabetes prevention behaviors among former Latinx DPP participants. Methods: This dissertation uses a mixed-methods research design. For the quantitative study (Aim 1 and Aim 2), I conducted a pooled cross-sectional analysis of four cycles of the National Health and Nutrition Examination Survey (NHANES) (2011-2018) among Latinx adults. I used the segmented assimilation theory as the guiding framework to classify Latinxs into subgroups according to socioeconomic status and acculturation level. Multivariable logistic regression iv models were used to predict the probability of individuals in each subgroup to engage in the two health behaviors, to fit prediabetes criteria, and to be aware of prediabetes. A qualitative descriptive study was employed to address Aim 3. Interviews with Latinxs who participated in a culturally adapted DPP were conducted. Interviews were audio-recorded, transcribed, translated, coded, and analyzed using a rigorous thematic approach with grounded theory components to allow a rich understanding of common themes based on participants’ experiences. Findings: The quantitative study included 3,558 Latinx adults, representing more than 25 million Latinxs living in the U.S. Six subgroups of Latinxs were created based on low/high SES and low/middle/high acculturation. I found subgroups of Latinxs showed different diet quality patterns, physical activity practices, and diabetes status. Qualitative results demonstrated the important roles of agency, socialization, and structure in supporting or discouraging former DPP Latinx participants in participating in DPP, attending the sessions, engaging in behavior change, and maintaining the behavior change after the program ended. Conclusions: This study provided comprehensive data about the interaction of individual, economic, and social processes in diabetes prevention behaviors among Latinxs. This includes the refinement of the health lifestyle theory for Latinxs who participate in DPP-like interventions, the importance of classifying Latinxs in subgroups in terms of diet quality, physical activity, and prediabetes, and a series of recommendations to improve the feasibility, effectiveness, and long-term impact of DPP for this population. Future efforts should continue to investigate how we can improve behavior change and support diabetes prevention behaviors by using an integrated approach to better address diabetes-related disparities, reduce the prevalence of type 2 diabetes, and improve the health and quality of life of Latinxs living in the United States.
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2022-01-01
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University of Kansas
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This item contains archived web content.
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FormaginiFarag_ku_0099D_18122_DATA_1.pdf
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Keywords
Health sciences, Public health, Behavioral sciences, Diabetes prevention, DPP, Healthy diet, Latino, Physical activity, Prediabetes