Hispanic Adult's Perceptions of Desired Knowledge for Eating Healthier and Motivators for Physical Activity

Purpose: In the United States, Hispanic adults have high rates of overweight (38.9%) and obesity (42.3%) and more than half (53.5%) do not meet the federal guidelines for physical activity (U.S. Department of Health and Human Services [USDHHS] & Office of Minority Health [OMH], 2015). Many Hispanics consume cultural diets that are high in fat and low in fresh fruits and vegetables. Further, nearly one third (31.7%) of Hispanic adults have prediabetes and 16.4% have diabetes as compared to the rate of diabetes among non-Hispanic Whites of 9.3% (Centers for Disease Control and Prevention, 2017). Hispanic adults are less likely to achieve glycemic control, more likely to be hospitalized for diabetes-related complications, and experience diabetes-related end-stage renal failure and lower limb amputations at higher rates than non-Hispanic Whites (USDHHS & OMH, 2016). Healthy eating and being physically active are essential self-care behaviors for preventing diabetes and managing the disease (American Diabetes Association, 2018; Powers et al., 2015). Given these statistics, understanding how to better promote healthy eating and physical activity among Hispanics has potential to improve health outcomes and decrease the health disparities of this population.

Using a qualitative study design, the purpose was to explore the perceptions of Hispanic adults living in the United States regarding their desired knowledge for eating healthier and identifying motivators they believe to be important for increasing physical activity. It was hypothesized the critical new knowledge would be learned to inform culturally, tailored, low-literacy education programs for Hispanic adults and family members for the self-management of prediabetes and diabetes.

Methods: A convenience sample of Hispanic adults was recruited from community clinics and Hispanic churches from a state in the southeastern United States. Inclusion criteria included being 18 years of age or older, self-identification as Hispanic or Latino, and the ability to speak and understand Spanish. Focus groups were conducted and led by trained, bicultural and bilingual Latinas. Sessions were conducted in Spanish and audiotaped. Data was transcribed into Spanish and translated into English by two experienced native speaking research assistants. The primary investigator (PI), who is bilingual, listened to the audiotapes and compared the transcriptions and translations for accuracy, completeness, group dynamics, and cultural context. Standard methodology for qualitative content analysis were conducted by the PI experienced in qualitative research to identify emerging themes, seeking similar or repeated ideas (Kreuger & Casey, 2015). A 20-item demographic questionnaire was completed. Frequencies and proportions were calculated for nominal variables and measures of central tendency for interval variables. Biophysical variables obtained included blood pressure, A1C blood test, height, and weight. Data collection occurred summer-fall of 2016.

Results: Three focus groups were conducted with 20 Hispanic adults. Most participants (90%) were immigrants, with the majority (75%) being from Mexico. The mean age was 43.9 years (SD 0.82) and more than half were female (55%). The average years of education among this sample was 10.5 (SD 3.07) and 60% did not have health insurance and only 20% spoke Spanish and English fluently. Twenty percent of the participants had been told by a healthcare provider that they had type 2 diabetes and 25% had been told they had prediabetes. The mean A1C was 6.04% (SD 3.07). When asked, “What information would you like your doctor or healthcare provider to tell you about eating healthier?”, three themes emerged: (1) Don’t just tell us general statements about eating, give us specifics; (2) Help us manage emotional eating and food additions; and (3) Family and friend support is necessary. The themes that emerged when asked “What would motivate you to be more physically active?” included: (1) Willpower and self-esteem; (2) Need a specific motivator; and (3) A good relationship with the doctor/healthcare provider is helpful. A final theme that encompassed all the data was “Our Hispanic culture.”

Conclusion: New knowledge and insight was gained from this sample of Hispanic adults regarding what information they believe to be important so that they can eat healthier and be more motivated to be physically active. Additionally, they highlighted a desire to have better communication with their healthcare provider and identified their healthcare provider as a key motivator for healthy lifestyle change. Understanding the cultural perspectives of this immigrant population is an essential part of providing person-centered care. The information learned from this study may be used to inform educational programs tailored for Hispanics for the management of diabetes, prediabetes, and obesity living in the United States or other countries.