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Explanatory models of diabetes in the U.S. and Mexico: The patient–provider gap and cultural competence


  • Weller, Susan C.
  • Baer, Roberta D.
  • Garcia de Alba Garcia, Javier
  • Salcedo Rocha, Ana L.


Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994–2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient–provider understanding.

Suggested Citation

  • Weller, Susan C. & Baer, Roberta D. & Garcia de Alba Garcia, Javier & Salcedo Rocha, Ana L., 2012. "Explanatory models of diabetes in the U.S. and Mexico: The patient–provider gap and cultural competence," Social Science & Medicine, Elsevier, vol. 75(6), pages 1088-1096.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:6:p:1088-1096
    DOI: 10.1016/j.socscimed.2012.05.003

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    References listed on IDEAS

    1. Hunt, Linda M. & Valenzuela, Miguel A. & Pugh, Jacqueline A., 1998. "Porque me tocó a mi ? Mexican American diabetes patients' causal stories and their relationship to treatment behaviors," Social Science & Medicine, Elsevier, vol. 46(8), pages 959-969, April.
    2. William Batchelder & A. Romney, 1988. "Test theory without an answer key," Psychometrika, Springer;The Psychometric Society, vol. 53(1), pages 71-92, March.
    3. de Alba Garcia, Javier Garcia & Rocha, Ana L. Salcedo & Lopez, Ivette & Baer, Roberta D. & Dressler, William & Weller, Susan C., 2007. ""Diabetes is my companion": Lifestyle and self-management among good and poor control Mexican diabetic patients," Social Science & Medicine, Elsevier, vol. 64(11), pages 2223-2235, June.
    4. Horton, Sarah & Cole, Stephanie, 2011. "Medical returns: Seeking health care in Mexico," Social Science & Medicine, Elsevier, vol. 72(11), pages 1846-1852, June.
    5. Cabassa, Leopoldo J. & Hansen, Marissa C. & Palinkas, Lawrence A. & Ell, Kathleen, 2008. "Azúcar y nervios: Explanatory models and treatment experiences of Hispanics with diabetes and depression," Social Science & Medicine, Elsevier, vol. 66(12), pages 2413-2424, June.
    6. Reimann, Joachim O. F. & Talavera, Gregory A. & Salmon, Michelle & Nuñez, Joseph A. & Velasquez, Roberto J., 2004. "Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model," Social Science & Medicine, Elsevier, vol. 59(11), pages 2195-2205, December.
    7. Cohen, Marlene Zichi & Tripp-Reimer, Toni & Smith, Christopher & Sorofman, Bernard & Lively, Sonja, 1994. "Explanatory models of diabetes: Patient practitioner variation," Social Science & Medicine, Elsevier, vol. 38(1), pages 59-66, January.
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    Cited by:

    1. Frank, Sarah M. & Durden, T. Elizabeth, 2017. "Two approaches, one problem: Cultural constructions of type II diabetes in an indigenous community in Yucatán, Mexico," Social Science & Medicine, Elsevier, vol. 172(C), pages 64-71.
    2. Forsyth, Colin, 2015. "Controlled but not cured: Structural processes and explanatory models of Chagas disease in tropical Bolivia," Social Science & Medicine, Elsevier, vol. 145(C), pages 7-16.


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