We found that Latinos with diabetes preferred a group-based diabetes intervention compared to a telephone-based one-to-one peer support program. Both interventions would provide opportunities to share knowledge regarding diabetes, but the group education model was perceived to offer more opportunity to engage with community members and learn from people with a range of experience with diabetes. Participants noted many grievances regarding the one-to-one intervention, such as the impersonal nature of telephone calls and wanting to interact with peers with a range of diabetes experience. However, participants believed the peer intervention could be a natural outgrowth of the group meetings.
Despite the recent increase in use of peer-based interventions, we found that not all types of interventions were acceptable to our participants. Most of our participants had concerns about a telephone-based one-to-one peer intervention. While Latinos have a high rate of cellular telephone use, many participants mentioned the difficulty of calling and getting in touch with participants due to busy schedules and competing interests.26
Additionally, contrary to other studies that support the use of telephone-based programs to provide participants with privacy and help them overcome geographic barriers, our participants desired face-to-face contact. The impersonal nature of telephone conversations impeded them from forming a trusting bond with their partner, especially with someone whom they have never met before. The idea of “simpatía,” an emphasis on the need for pleasant social relationships, and “personalismo,” a desire for a formal friendliness with others, may have impacted their preference for face-to-face contact with peers.27
Even when recruiting participants for our study, we found that we had more success through direct contact with people than through posted flyers.28
Additionally, geographic distance may not have been a significant barrier in connecting peers in our study population due to the density of Mexican-Americans in the neighborhood we recruited our sample from.24
Other studies have noted the success of collective learning, but our study is the first to elicit preferences for group education compared to one-to-one peer interventions among Latinos.7, 29
Despite concerns about competing time commitments affecting attendance, our participants suggested that the groups provided opportunities to discuss shared experiences, learn how others solved problems that arose in diabetes self-management, provide each other motivation, and interact with others who had a range of diabetes experience. The preference for group learning may also reflect their shared sense of community. Many participants had leadership roles in the community and enjoyed interacting with their fellow community members. This desire to interact with community members may have extended into their preferences for group-based diabetes interventions. However, this may only be a partial explanation for our findings, since some participants were socially isolated and wanted to find companionship in their community through this group interaction.
Although participants had concerns about one-to-one peer telephone interventions, they were not opposed to interventions that utilized peers. Participants wanted community members who had expertise in medicine, nursing, and community health to be involved and lead group sessions. Additionally, participants believed the believed the group based-program could naturally lead to a one-to-one program. Once people became acquainted in the groups, they could break off into dyads. The one-to-one program could be a supplement to group-based program and provide motivation and support to participants in between group sessions.2
Lastly, while most supported the idea of having these interventions in the familiar setting of a church, we found that many people did not specifically say how these programs would be different in the church versus other community settings. Thus, these preferences for programming may be applicable to settings outside of the church as well.
Our study has several limitations. Our findings may not be generalizable to all Latino persons with diabetes since our focus groups were conducted with mostly Mexican Americans from Catholic churches in one Midwestern city. However, Mexican-Americans represent the largest population of Latinos in the United States, and most Latinos in the U.S. are Catholic.16, 30
Additionally, the participants’ preferences for group-based interventions may have been a reflection of their satisfaction with their involvement in groups in and out of the church. However, not all the participants in our focus groups were actively engaged in their communities or in the church. Our participants also had a higher level of education, income, and health insurance than national averages for Latinos, although the barriers they listed in receipt of care were similar to other studies with Latinos.9
Our participants may have given socially desirable answers during the focus group discussions, and some participants may have been more vocal than others. Yet, we found that the respondents repeated similar stories across the focus groups, reassuring us that we did capture the most common responses as well as a wide range of beliefs.