Using the PEN-3 Model to Assess Knowledge, Attitudes, and Beliefs about Diabetes Type 2 among Mexican American and Mexican Native Men and Women in North Texas

Introduction Type 2 Diabetes Mellitus (T2DM) is currently the sixth leading cause of death for all groups in the United States. (1) The prevalence of this disease is disproportionately higher among the Hispanic population, representing their fourth leading cause of death, claiming nearly 6,000 deaths annually. (2) The Centers for Disease Control and Prevention [CDC] reported over 15 million people currently live with T2DM in the United States. (1) This represents a 50% increase in diagnosis from five years prior. In addition, it is estimated that another 6 million people remain undiagnosed. Mortality rates associated with T2DM are actually three times higher for the Mexican-American (MA) and Mexican Native (MN) populations due to co-morbidities and underlying causes. (3) Texas has some of the highest rates of T2DM in the U.S. The prevalence of people diagnosed with T2DM in Texas has increased each year since 1995. (4) Furthermore, as of 2003 the death rate from T2DM among MA & MN men and women in the Border States, including Texas, was 27.6 per 100,000, second only to African Americans. As this population continues to grow in Texas, culturally competent T2DM education is vital for prevention, care, and program development. Addressing all "Hispanics" categorically is a weakness of previous studies. This categorization assumes, from a research standpoint, that the health status of all individuals classified within this governmental term is homogeneous. (5) The 2000 US Census reported the total Hispanic population in Texas at 6,669,666 (32%). Of that, 5,071,963 (24.3%) are of MA or MN decent and the remaining 1,597,703 (7.7%) had no ties to Mexico. (6) The methodology of these programs must expand from a standardized Caucasian-centered approach to a culturally tailored approach designed specifically for implementation among the subset of MA & MN. Compared to other groups, MA & MN patients experience an increased gap in knowledge pertaining to T2DM. (7) These factors are partially tied to the acculturation process and may include language barriers, mistrust in the diagnosis, soaring cost of health care, use of home remedies, and a fear of asking questions. (8) Diabetes education programs may also fall short if individuals feel they have the disease under control, do not perceive the benefits of exercise, or do not perceive the need to change eating habit. (9) Chesla, Skaff, Bartz, Mullan, and Fisher (10) evaluated the levels of understanding related to T2DM between Caucasian and MA & MN men and women. Compared to Caucasians, MA & MN men and women emphasize the symptoms of T2DM (e.g. excessive thirst, urination, and appetite, fatigue, vision problems, erectile dysfunction, and slow healing infections) (11) rather than the biological characteristics. MA & MN adults who emphasized biological factors generally have higher levels of education and acculturation to American practices. Attitudes toward learning or behavior change in this community center on gaining the respect and trust of participants. (12) Ethnic non-majority groups comprise the majority of diabetic patients in the United States. (13) MA & MN, representing the largest Hispanic subgroup, have the highest prevalence of both undiagnosed and diagnosed T2DM. It is essential for patients with T2DM to maintain a thorough understanding of the disease. At present, less than half of all MA & MN patients with T2DM have ever attended a diabetic education program. (14) However, Borrell, Dallo, & White (15) believed appropriate education can address positive health behavior changes such as proper nutrition and adherence to medical orders. This group is receptive to diabetes education and willing to change harmful behaviors. (16) In order to make this a reality, health educators need to adapt communication methods which include this culture. (17) Purpose of Study and Significance The primary purpose of this mixed-methods study was two-fold: first, to assess diabetes knowledge, attitudes, disease management and self efficacy among a sample of Mexican American (MA) and Mexican-Native (MN) adults living in North Texas; and second, to determine factors which promote or deter diabetes prevention and management using Airihenbuwa's PEN-3 Model. …