The purpose of this study was to explore from an emic perspective the acculturation experiences of Mexican American immigrants living in Missouri with respect to their self-management for type 2 diabetes. Because the incidence of diabetes is rising among Mexican Americans and the prevalence is twice as high as for non-Hispanic whites, an etic perspective of vulnerability for this ethnic population already exists. Rates of diabetes have been associated with acculturation and lifestyle changes. Berry's (1980) theoretical model of acculturation was used to conceptually frame this study. An ethnographic methodology involving formal interviews, participant-observation, and two case studies was used with a convenience sample of ten Mexican American informants (7 women and 3 men) with type 2 diabetes mellitus from northern and central Missouri counties. Acculturation and marginality were assessed with the second Acculturation Rating Scale for Mexican Americans (ARSMA-II). A template analysis of illness narratives and self-care practices, based on Leventhal's Self-Regulation Theory, revealed a predominantly biomedical perception of diabetes among informants. Only two informants used traditional cultural remedies and were doing so to avoid insulin therapy. Causation of diabetes was attributed to either emotionally distressful experiences or hereditary. An editing analysis of interview transcripts revealed ten themes related to acculturation experiences. Themes which emerged from the data were 1) "En las familias, generalmente son las mujeres quienes dan el cuidado [In families, generally women are the ones who give care];" 2) "Descubri aquí que tenía diabetes [I discovered here that I had diabetes];" 3) "Los medicos no hablan español [The doctors don't speak Spanish];" 4) "Eso es lo que queria saber [This is what I would like to know];" 5) "Tomo mucha agua [I drink much water];" 6) "El cuidado en Mexico o allá de donde soy yo [The care in Mexico or from where I come];" 7) "Los servicios medicos y las medicinas aquí cuestan mucho [The medical services and medicines here cost much];" 8) "Me puedo cuidar [I can care for myself];" and 9) "Me discriminaba [I was discriminated against]." Primary self-care issues in the Midwest, expressed by informants, pertained to the limited Spanish proficiency of U.S. health providers and the high cost of health care. Implications for nursing practice addressed language limitations of health providers, economic issues for immigrants, and screening practices for diabetes. Implications for nursing research included under-representation of non-English speaking populations, qualitative data analysis in native languages, influence of secrecy on screening data, and the multiple environmental contexts involved in cross-cultural research. These findings will be used to develop a culturally appropriate diabetes education program for Spanish speaking populations in this region of Missouri.
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