BACKGROUND: Clinicians are often concerned that use of alternative treatments by Mexican American patients with diabetes competes with medical treatment. We examined the use and evaluation of alternative treatments for diabetes by a sample of these patients.
METHODS: Following a descriptive qualitative design, a convenience sample of 43 low-income Mexican Americans with type 2 diabetes were interviewed. We analyzed interview transcripts for alternative treatments named, patterns of use, evaluation of those treatments, and the use of biomedical approaches. We crosschecked the results for interrater reliability.
RESULTS: Herbs were mentioned as possible alternative treatments for diabetes by 84% of the patients interviewed. However, most had never or rarely tried herbs and viewed them as supplemental to medical treatments. Most said prayer influences health by reducing stress and bringing healing power to medicines. None used curanderos (traditional healers) for diabetes. Most actively used biomedical treatments and were less actively involved in alternative approaches. Statistical tests of association showed no competition between biomedical and alternative treatments, and alternative treatment activity tended to be significantly lower than biomedical. Most study participants emphasized medical treatment and only used alternative treatments as secondary strategies. Those patients very actively using alternative approaches also tended to be very actively using biomedical methods; they were using all resources they encountered.
CONCLUSIONS: Traditional attitudes and beliefs were not especially important to the patients in this study and presented no barriers to medical care. For these patients, it also cannot be assumed that belief in alternative treatments and God’s intervention indicate fatalism or noncompliance but instead require consideration of individual treatment behaviors.
Alternative medicine has increasingly become the subject of medical research, in part driven by a concern that such treatments, despite their apparent innocuousness, may harm patients by exposing them to unknown dangers or by drawing them away from medical treatments.1-7 As many as 1 in 3 people in the United States report using alternative treatments, most often for chronic illnesses such as diabetes.8 More than 400 herbal remedies for diabetes have been reported worldwide.9-11 Mexican Americans, who have rates of type 2 diabetes at 2 to 3 times that of the general population,12 also show high interest in alternative medicine, with as many as 67% reportedly using folk remedies.13-15
Although many clinicians worry that alternative treatments may present barriers to effective health care for Mexican American patients with diabetes, research does not support this concern. Several previous studies have focused on alternative treatment use by Mexican Americans,13,14,16-21 but these treatments were not shown to be highly prevalent or of great importance to this group. For example, although many studies have examined use of herbal remedies,22-26 the traditional healers called curanderos,13,17,27 and health-related religious beliefs,4,28-32 most merely report the frequency of these beliefs and practices, without explicitly examining how patients use and evaluate such treatments. There has not been careful consideration of the relative importance of these approaches to the health care of individuals or of how their use affects the utilization of biomedical treatments.
Since noncompliance with medical care is of great concern for physicians of patients with type 2 diabetes,33-36 the question of whether there is competition between biomedical and alternative treatments for this group is an important one. However, a great deal of previous research by anthropologists and other social scientists indicates that this may not be a realistic concern. It has been consistently found that in everyday practice people draw on different health systems simultaneously, using various treatments as complimentary rather than competing alternatives.8,14,37-50 Thus, to understand the role that alternative treatments may play in managing diabetes, it is necessary to not only explore whether those therapies are known and used, but also how their use is integrated with use of biomedical approaches.
We report on a descriptive study of a group of Mexican American patients with type 2 diabetes. We examined how they say they use and evaluate alternative treatments and how they integrate them with conventional medical care.
Methods
Patient Selection
In 1994 and 1995 we discussed alternative treatments for diabetes with a convenience sample of 43 self-identified Mexican American patients. These patients were visiting at 2 public clinics serving low-income patients in San Antonio and Laredo, Texas, for type 2 diabetes. We included patients who had type 2 diabetes for at least 6 months before the interview, had no major impairment because of diabetes, and gave informed consent to be interviewed in their homes. Fifteen patients were recruited while waiting to see internal medicine physicians at the San Antonio clinic. The rest were participating in patient education trials as part of a larger project being conducted by the Texas Diabetes Institute. Nineteen of these were part of a diabetes patient education trial at the San Antonio clinic, and 9 were part of an evaluation of a provider education trial at the Laredo clinic.