Background: Latina older adult women disproportionately suffer from type 2 diabetes (diabetes) and symptoms of depression and/or anxiety. These disease states are associated with serious declines in health outcomes and a three-fold reduction in treatment compliance. Few studies have examined this phenomenon exclusively among Latina older adult women or have captured the impact of intersectional identity on their experiences, values or problem-solving methods related to self-management.
Purpose: The purpose of this study was to examine how Latina women, 60 and over, emotionally experience both diabetes and interactions with care providers during help-seeking and care engagement.
Methods: This qualitative study used constructivist Grounded Theory methodology to explore the experience of English-speaking, Latina women, 60 years and older, diagnosed with diabetes and experiencing symptoms of depression or anxiety. Twenty-one phone interviews were conducted (N=16), with the use of a semi-structured interview guide. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were administered to assess the presence and extent of participant symptoms of depression and/or anxiety.
Findings: Participant data informed the creation of a theory, titled The Secret Self-Management Loop (SSML). This theory reflects four interconnected categories, or phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and, 4) engaging in secret self-management. These phases cumulatively reinforced participants’ lack of trust in their providers and the medical system. In response to this lack of trust, participants employed a number of strategies they did not disclose to their providers, including the use of traditional medicines on the advice of lay providers and family and self-adjusting their prescribed antihyperglycemic medications. Participants also identified their own anecdotal benchmarks for diabetes management and valued these over diagnostic tests traditionally used by endocrinologists. Insufficient time with providers and providers’ lack of familiarity with Latino/a/x cultural practices were primary sources of emotional disconnection that underpinned this lack of trust.
Conclusion: The four-phase SSML is a dynamic and continual process that negatively influences disclosure within the patient-provider dyad and distorts providers’ ability to adequately render care for Latina older adult women experiencing diabetes and symptoms of depression and/or anxiety.
Implications: These findings have clinical, educational and research implications for nurses, physicians and other care providers working with Latino/a/x older adults living with diabetes and symptoms of depression and/or anxiety. Specifically, these findings illuminate the need for strategies and interventions to improve bonds and increase disclosure within the patient-provider dyad. Interventions promoting patient empowerment, increased diversity in the healthcare fields, and provider training in Latino/a/x cultural practices represent potential solutions to the current disconnect between Latina older adult women and their providers.