Fighting fatalismo: Improving diabetes self-management in the Hispanic community

Not long after Francisca “Fran” Trujillo entered The University of Tulsa’s Doctor of Nursing Practice program, she kindly sat for an interview and video. At that time (mid-2017), Trujillo shared glimpses of her inspiring journey from undocumented immigrant to work around the corner from TU at Bama Pie to an active and varied career in nursing.

During her final term as a DNP student, we caught up with Trujillo (DNP ’19) again for another chat. This time, however, the focus was on the culminating research project she completed as part of the program. We also got a chance to learn about Trujillo’s plans for life after graduation.

Fatalismo

Diabetes is one of the scourges of life in many Western countries. Compared with the general population, Hispanic people in the United States are disproportionately more vulnerable to adverse diabetes outcomes and they suffer from additional risk factors.

“There are a number of common misconceptions in Hispanic culture that make diabetes self-management challenging,” explained Trujillo. “For example, fatalismo (fatalism) is a widespread attitude that regards death as inevitable and efforts to improve one’s health as futile.” Trujillo’s experiences with her own family members as well as her nursing work for 11 years in diabetes education in a community health setting made her aware of the fact that “this misconception is a major barrier that leads to Hispanic patients feeling powerless over their diabetes self-management. Ultimately, this leads to poorly controlled diabetes, increased health care spending, greater suffering and premature death.”

Taking control

Given these conditions, Trujillo decided to tackle fatalismo head on: “Diabetes can be controlled. It doesn’t have to be a death sentence.”

The goal of Trujillo’s research project was to determine whether culturally adapted diabetes self-management education (DSME) at a safety-net clinic in northeastern Oklahoma would improve knowledge, disease management and self-efficacy among adult Hispanic patients diagnosed with type 2 diabetes.

“I developed this project to intervene by providing the diabetes education to 70 patients in Spanish. The main component was a curriculum – titled Diabetes is Not a Death Sentence – adapted to fit the needs of the clinic’s patients and that addressed the misconception of fatalismo.”

Because this was a research project, Trujillo developed tests to measure baseline knowledge and then to gauge awareness after the intervention. She also created a lifestyle survey to gather information about patients’ habits prior to the intervention as well as three months following because, Trujillo explained, “I wanted to give patients enough time to implement the new knowledge they had gained.” In addition, she followed up with patients (primarily by phone) two weeks and one month after the intervention in order to see whether they had any concerns or questions. Some, for instance, asked about hypoglycemia, depression, insulin and nutrition.

Good outcomes

A broad smile swept across Trujillo’s face as she began to describe the “good outcomes” that arose from her project. “Comparing the pre- and post-tests, I found that patients’ knowledge increased significantly. At the post-test, more patients knew that diabetes is not a death sentence, more knew that insulin is not addictive and more knew the importance of checking their feet every day.”

The post-intervention lifestyle survey, meanwhile, revealed that all the study participants now knew the sugar and fat content of their diets. Most, also, had shifted to “low” or “moderate” sugar and fat consumption.

As she looks to the future, Trujillo has her sights set on expanding her project to a longer-term study. “In addition to measuring lifestyle changes and knowledge gained, I would like to evaluate A1Cs, lipid panels and blood pressure to see whether DSME is having an impact on patients’ health,” she said.

Are you a nurse who would like to advance to the next level of health care professionalism? TU’s DNP program might be the right path for you.