This study addresses limitations of the current literature by providing deeper investigation about how and what low income African American and Latino participants feel is missing in the care of their diabetes and hypertension to help frame interventions specific to expressed participants’ needs. Results of these focus groups established overlying themes that are common among the experiences of non-Hispanic Black and Latino participants. We found 1) gaps in participants’ knowledge and understanding of the nature of diabetes and hypertension; 2) that stress was a factor that strongly affected the condition, self management, and lifestyle of participants; 3) participants were challenged by a need to change their traditional eating and exercise habits; 4) that many participants reported they could not buy the healthier foods suggested to them by nutritionists at an affordable price; 5) exercise was a challenging factor, especially for participants in the Latino groups; and 6) participants suggested that implementing group education and exercise classes and assisting with transportation to their health center may be helpful strategies to improve care and outcomes from their disease..
Our findings on the role nutrition and exercise play in patients’ experience with disease are supported by existing literature7,10,12,14
. For example, Hatcher et al. reviewed15
research reports on Hispanic adults’ beliefs and found that many Hispanics reported having difficulty following prescribed diets within their traditional diets and that the high cost of health foods was a barrier12
. Burns et al. conducted interviews with diabetic study participants and found that an effort to eat right was a daily challenge and that the cost and availability of desired foods hindered appropriate self-management.7
Cost is not only higher for healthier foods, but frequently healthier foods are absent from grocery stores in lower socioeconomic neighborhoods7,9,13,17
. Among our study population, one major barrier expressed by participants was difficulty breaking the habit of eating unhealthy foods that are commonly found within their community and in traditional ethnic foods. Similarly, other studies have demonstrated that many individuals in the Latino population do not embrace the idea of exercise7,12
. For example, one study found that for some Latinos, the amount and intensity of needed exercise varied with some believing that housework was sufficient exercise.12
The origins of stress that were highlighted in our focus group discussions were often cited to be due to the environment, specifically neighborhood safety, crime and poor conditions in the neighborhoods, as well as the fast pace of daily lives9
. Depression was also a reoccurring theme that affected the ability of patients to manage their conditions7,9–11,16
. Our findings suggest, however, that under-treated depression complicates patients’ ability to self-manage their disease although no formal diagnoses of depression was verified by a medical provider.
Our focus group participants identified several possible areas and recommendations for interventions. First, participants suggested improving physician counseling regarding the mechanisms behind these chronic diseases including recommending care that focuses on preventing diabetes and hypertension. Participants suggested this could be accomplished by being provided with varied pamphlets or other literature in their language and having longer physician visits or through the creation of interactive discussion groups in order to learn about their disease. Additionally, participants suggested establishing interactive discussion groups for community members with diabetes and hypertension focused on lifestyle modification to prevent complications from these diseases. Such groups would be composed of patients with similar illnesses to listen and share information. Important topics of discussion would include clarification of the type of diabetes they have, explanations of what diabetes and hypertension actually are, what they affect, the long-term effects that may be expected (etiology, prognosis, and progression), and management techniques7,8
There are several potential limitations of our study. Although focus group research is a valuable and effective method for exploring health-related needs and perceptions of the health care system, they may include a self-selected group of individuals who are more articulate about the opinions than non-participants, may limit the discussion from participants who are concerned about disclosure of sensitive information to the remainder of the group, and/or may include participants who have had more extremely negative or positive experiences than the norm, potentially leading to biased results. For example, in a prior study utilizing site visits to each of the participating health centers we found that each center attempted to have language concordant materials about diabetes available18
, however participants in our groups stated this type of material is often not given to them. This finding may signal that the presence of language concordant educational materials isn’t sufficient alone in communicating health information, or instead, participants in our focus groups may have been disproportionately unaware of services available within their center compared to non-participants.
We did not have information on those who refused to participate, however, non-Hispanic Black men were under-represented in the focus groups when compared to those who agreed to a follow-up phone call and as a result, if there are differences in experiences and recommendations that differ by race and gender, those of non-Hispanic Black men may be inadequately represented. The study may also be biased toward women as most of the responders were female. The overall number of persons who participated in the focus group may not be representative of the larger population and thus the findings may not be generalizable. Results of our study did capture the beliefs and challenges faced by non-Hispanic Black and Latino patients with diabetes and hypertension in an urban setting. The study also presents suggestions from patients to health care providers with regard to effective preventive interventions that would enhance patient knowledge base and self-management skills.
Our findings support results from other studies and concur that interventions for prevention need to be developed with input directly from affected population groups7,9–11,17
. Participants of this study stated that they would benefit from ongoing interactive discussion groups to gain management skills, education, and support for their conditions, which would increase awareness about diabetes and hypertension. Such ongoing groups need to provide support for patients in creative ways, including assistance in the adoption of healthy nutrition plans that complement their ethnic diets. Furthermore, groups need to allow for exercise opportunities and provide coaching on methods to prevent or minimize disease manifestation within their families of the participants. Further studies are necessary in order to evaluate the effectiveness of interactive diabetes and hypertension groups that are both patient-based and apply patient racial and ethnic traditions.