Cultural Influences on Dietary Choices of Mexican Americans with Type 2 Diabetes: A Qualitative Synthesis

Diabetes care and education focuses on knowledge and self-management behaviors related to physical activity, healthy eating, taking medication, monitoring, reducing risk, and problem-solving.1-3 Certified Diabetes Care and Education Specialists provide individualized nutrition counseling and other behavior change strategies.4 Although nutrition counseling may be straightforward, such as recommending consistent carbohydrate intake at each meal, cultural foods and beliefs influence dietary choices and should be a consideration when counseling individuals of ethnically diverse backgrounds.In the United States, ethnically diverse populations are disproportionately affected by type 2 diabetes (T2DM). Among Mexican Americans, the rates of T2DM are much higher (24.6%) than the overall US population (14.6%).5 Mexican Americans comprise 11.2% of the US population, and from 2010 to 2020, the Hispanic population grew by 23%, accounting for more than 50% of the population growth.6,7 The rate of T2DM prevalence is tied to age, family history, sedentary lifestyle, history of gestational diabetes or prediabetes, and overweight status, which are factors strongly linked to diet quality.8Studies with Mexican Americans and Puerto Ricans suggest that including ethnic and cultural preferences can improve glycemic status and reduce the incidence of complications.9-13 Some examples of ethnic and cultural adaptations include the use of traditional foods, such as tortillas, rice, beans, and different forms of chili peppers; providing health information in the preferred language; and including a paraprofessional with a high degree of cultural and community knowledge as part of the health care team. However, it is still unclear which and how cultural adaptations influence self-management behaviors relative to diet, a cornerstone for ameliorating T2DM complications.Studies with Mexican Americans and Puerto Ricans suggest that including ethnic and cultural preferences can improve glycemic status and reduce the incidence of complications.Resnicow and colleagues14 describe a cultural sensitivity model for public health interventions that provides a comprehensive approach to understanding how cultural influences may impact behavioral interventions for disease prevention.14 This approach distinguishes the types of cultural influences as either surface or deep structure. Surface-structure influences are those observable or “superficial” characteristics of a target population, such as using