“It’s Not That We Care Less”: Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos
Abstract
:1. Introduction
Barriers to and Facilitators of Healthcare Access
2. Materials and Methods
2.1. Sample
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. Structural Barriers
3.1.1. Financial Burden
“Here in the United States, medicine is a business, and the business is for those who have money, not for those who do not have it. People do not go and won’t go to see a doctor, and all this will continue as long as there are not enough funds to help Hispanics and other poor people.” (Member from focus group 5).
“I never went for an exam for prevention—never, never. Why? It has to do with this [makes money gestures with fingers]: if you don’t have health insurance, they will charge you for the exams. So, I have to put this into balance and say, “Do I put bread on the table for my family, or do I go to the doctor?” What do I do? I have to put food on the table.” (Member from focus group 1)
“I have lived here for 16 years. Many people do not go to the doctor. They do not have the hours at work. If they miss a day, you are told, ’You are fired’... or you cannot go because you are needed in your section; so many people cannot go to the doctor because they do not want to lose their jobs.” (Member from focus group 4)
“It’s very hard economically. People say you’ve got to diet, and then when you have a big family, it’s very hard to buy foods that are nutritional because it’s very expensive ... When you come from a big family, and you go grocery shopping, and you try to stretch your money, so you buy whatever there is that is cheaper to put food on the table. Actually, you should buy healthy food, but that is very expensive. The government doesn’t help.” (Member from focus group 8)
3.1.2. Access to Information
“if you don’t know, you’re not going to be doing anything about it.” (Member from focus group 8)
“Last time they sent me [for this procedure], but they never told me that I had to go a few days before ... I went straight to them. It wasn’t there in the clinic. It was elsewhere. ... My husband didn’t go to work to take me, but they [clinic staff] didn’t explain it to me well. They never explained to me what it was.” (Member from focus group 7)
“Definitely, I believe that the key is that we do not have information, and many people have not had information, but it is because of the fear of approaching to seek information, fear of approaching hospitals because there are no resources. Often, we do not have money. We don’t have insurance. We have no way of getting anywhere because we say, ’Why should I go if I don’t have insurance?’ We do not have help right away, definitely, and it is fear. We fall into the same thing, it is fear—fear for their immigration status, fear for so many things we hear [happening] around here.” (Member from focus group 5)
3.1.3. Navigating Healthcare Institutions
“All of my uncles are diabetic, and I have many diabetic cousins, but I don’t take care of myself. I eat everything, but well, it is like that here [in the US]. We are always running from one place to another. So, we cannot eat healthy because those of us who work a lot work more than eight hours. We arrive, and we make some food quick, not very nutritious... So you eat whatever you can to take the hunger away, and you don’t eat healthy.” (Member from focus group 1)
“Because we are Latino and we carry the color of our skin, they have discriminated against me. They think I don’t know anything.” (Member from focus group 1)
“Sometimes there are people who do speak Spanish but do not want to speak it. It is the new racism that the current president [POTUS 45] is imposing. It will be worse because we are already afraid even to speak our language because you speak Spanish, and then others are turning to see you. I imagine that this means we will be less able to have help for Latinos in their language.” (Member from focus group 7)
3.2. Personal Barriers
3.2.1. Fear
“There are many barriers for us as Hispanics, mainly because of the immigration system right now. There are many people who are afraid to seek help, afraid of going to hospitals for fear of being asked about their immigration status.” (Member from focus group 5)
“Many people stop going to the doctor even if they feel bad because they say the doctor will find thousands of new things in them. They start with the lab studies and analysis, and that’s where they begin to realize, ’this person is suffering from this, the other, and the other,’ and that’s where they say, ’I told you, what’s the purpose of going to the doctor? To find out that I have thousands of diseases. It’s better not to go and wait until something hurts. At that point, I will take a pill. When another thing hurts, I will take another pill.” (Member from Focus group 5).
“We [Hispanics] never go to a doctor, only when we feel that we are dying.” (Member from focus group 4)
“I think it is part of our culture to say, ‘I feel a little better now, and that’s fine’, so we stop taking the medication, stop attending consultations and doctor appointments. So, I think it’s part of not being responsible for yourself. We are harming ourselves.” (Member from Focus group 5).
“Sometimes we as Hispanics tend, as we say, ’we care less.’ They diagnose some disease, and we take it lightly. Nothing happens, or a person comes and tells us, ’Take this because this will help you.’ Sometimes, we simply do not go to the doctor, but we ignore what we really should do and do other things that we should not do, such as going around self-medicating, because that is what is common. We self-prescribe before going to the doctor. Why? Sometimes, our budget is insufficient, and sometimes, the person does not have health insurance. There are several things, but as Hispanics, we tend not to pay attention to the real stuff that we have to focus on, such as the disease, which is something essential that we have to have first in mind, that we have to take into account that we have to take care of ourselves.” (Member from focus group 5)
3.2.2. Family Dynamic
“The truth is, in my home, there has been no support from my partner. I decided to change my life because I have my children, and I have always tried to do the best for them, to work for them because I don’t want my foot severed tomorrow or they take an organ out of me because they are still little. They cannot stand on their own. On the part of my husband, I have never had his support. I have always tried, I cook this, this is what we are going to eat, but he always goes, ’No, if you give it to me, give me four portions of food,’ and not a portion like this [signals small amount], but a portion like this [signals a large amount] and I say to him, ’you are going to eat all of that?’ and he says, ’Yes, and it won’t even fill me up,’ and I tell him, No.” (Member from focus group 2)
“You go to the psychologist, you’re crazy, always the negative, but therapy does help because people go for many situations. Many people may be divorcing... many are afraid to tell their family they need help because they are ashamed. Many people are ashamed that they need that help and are afraid to tell the family, ’Look, I feel like this’ because then the family is like, ’I don’t want to hear it.’ They don’t want to accept that.” (Member from Focus group 3).
“...every day it will get worse if there is no one to encourage you.” (Member from focus group 6)
3.3. Structural Facilitators
“I think possibly if you, as educators, would pass on your knowledge to maybe somebody from the community who actually has gone through it, that way they can share their stories, share their progress. I think when people know other people who are close to them or take some role in their daily lives, I think it would encourage them to want to seek help or to hear a personal story from somebody that they know and how they changed their life. I think that would be helpful.” (Member from focus group 8)
“For people who might know something, it is super important to share information and keep sharing so they do not have these fears. Because there is a lot of fear in our community, we know this, with people with no immigration status, and this type of government that we have is so hard, right?” (Member from focus group 1)
“You should see if there are support groups, churches, or people in the clinics. Ask to see if there are support groups because sometimes they have support groups that can help you. You hear other stories; you hear someone else’s, and sometimes it helps you because you see that you are not alone.” (Member from focus group 3)
3.4. Personal Facilitators
3.4.1. Family Support
“My son has taught me a lot. He has helped me in that aspect... He says, ’No, Mom, it’s that we have to take care of ourselves. You have to take care of yourself.’ And the truth is, I have learned a lot from him because he always wants healthy things. ...he always does so much exercise. He is always busy exercising. He says to me, ’Mom, you can do it,’ he says, ’We are going to eat salads.’ With his plates of salmon and salad...” (Member from focus group 1).
“I used to be ignorant about hypertension or diabetes until I married B. I learned what is part of having discipline and a new way of life because she weighs less, and together, we are learning. I had a sweet tooth. To support her, I had to convert to half-and-half, some vegetarian, and a little carnitas, and I was removing it little by little. ...now I know that when her skin is dry, which is one of her symptoms, I can see her eyes, and I know the first thing I ask her is, ’Did you check?’ ’How was it today?’ When it [sugar level], is low, we can enjoy ourselves. When it is high, I have to skip a snack too. Because if one of you is going through the disease and the other doesn’t have it, we have to for the team. It is a change in our social life.” (Member from focus group 2)
“I have gone through many depressions. I am not going to say that they went away; from time to time, I fall into depression, but a mild one. He [my spouse] said to me, ’We are going to this place’. We went out, and it distracted me. I forgot. Depression is something tremendous because I even thought about hanging myself in the tree on my patio so that they would find me there. I thank God because he took away the bad things I was thinking about doing.” (Member from focus group 2)
“When I got pregnant with my son, I took my son to the psychologist, and I said, ’Look, I have this little angel that God sent to me to continue forward, and this will be my motor, this will be my psychologist, this will be my help.’ It was like I had come out ahead with his child, and sometimes I may trip and fall, but I always get up. But I have never taken the decision to commit suicide, no. Suicide, never.” (Member from focus group 1)
3.4.2. Spirituality
“I believe in my faith and the strength that God gives me because I get up early and don’t feel as tired...” (Member from focus group 7)
“As I am now, if I get sick, the best doctor I have is God. I give him all my problems and all my illnesses. I want to make myself drink my juices... I do go to the doctor, but my barrier is that I cannot go alone because I don’t know how to get in a car and leave. It takes my daughters to get me to move. That is difficult for me, but I always go to church and ask God, ’Lord, I give myself to you because you are my best company. What I am taking is for my own good, for me to feel better’. Give everything to God so that God can help us.” (Member from focus group 6)
“We have the opportunity to go to the best known and most effective doctor in the world, who I think is God.” (Member from focus group 4)
“...thank God today I am standing because I asked God to give me a good doctor. God gave me and thank God and the doctor because science is there because God has left it for us. Thank God, and to her, I am on my feet...” (Member from focus group 3)
4. Discussion
4.1. Barriers to Care
Structural Factors
4.2. Personal Factors
4.3. Facilitators to Care
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Key Category | Theme | Sub-Theme |
---|---|---|
Barriers to healthcare and mental health access and sustained treatment engagement | Structural Barriers | Financial burdens (i.e., healthcare, food costs) |
Navigating healthcare institutions (i.e., discrimination and racism) | ||
Lacking access to information (i.e., resources in Spanish) | ||
Facilitators with healthcare and mental health access and sustained treatment engagement | Personal Barriers | Fears (i.e., immigration and health status) |
Personal responsibility (i.e., unhealthy eating behaviors) | ||
Family dynamic (i.e., unsupportive) | ||
Structural Facilitator | Having accessible information in communities and churches | |
Personal Facilitators | Family support; spirituality |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Borja, S.; Valdovinos, M.G.; Rivera, K.M.; Giraldo-Santiago, N.; Gearing, R.E.; Torres, L.R. “It’s Not That We Care Less”: Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos. Int. J. Environ. Res. Public Health 2024, 21, 148. https://doi.org/10.3390/ijerph21020148
Borja S, Valdovinos MG, Rivera KM, Giraldo-Santiago N, Gearing RE, Torres LR. “It’s Not That We Care Less”: Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos. International Journal of Environmental Research and Public Health. 2024; 21(2):148. https://doi.org/10.3390/ijerph21020148
Chicago/Turabian StyleBorja, Sharon, Miriam G. Valdovinos, Kenia M. Rivera, Natalia Giraldo-Santiago, Robin E. Gearing, and Luis R. Torres. 2024. "“It’s Not That We Care Less”: Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos" International Journal of Environmental Research and Public Health 21, no. 2: 148. https://doi.org/10.3390/ijerph21020148