Specific aspects of culture relative to Mexican-Americans have not been characterized relative to medical nutrition therapy (MNT) and/or education for in type 2 diabetes mellitus (T2DM) self-management and other health problems. The objective of the study is to add meaningful insight into culturally relevant aspects necessary for the development and/or adaptation of T2DM self-management programming for Mexican-Americans. To accomplish this, aspects of culture relative to T2DM self-management are explored through several innovative approaches. First, using a content analysis approach, an in-depth examination of literature on the perceptions of Mexican-Americans on self-management diet and physical activity behaviors was completed to identify cultural elements. Next, perceptions of culture by nutrition experts, specifically targeting registered dietitians, were examined using an online survey that explores cultural elements used in practice when counseling Mexican-American diabetes patients on achievement of self-management goals. Finally, curricula used in T2DM interventions that target Mexican-Americans were examined using a content analysis approach for the extent to which cultural elements are integrated into the written curricula. Results from the first aim identified several surface and deep level cultural elements. The top surface level elements mostly frequently found in the qualitative studies were food habits (n=15/19), food preferences (n=14/19), use or acquisition of nutrition knowledge (11/19) and healthcare provider preferences (11/19). The top three deep level elements most commonly found were general health beliefs or attitudes (n=19/19), beliefs or attitudes about foods in general (n=17/19) and family turmoil (n=14/19). Findings from the second aim demonstrated that Registered Dietitian Nutritionist (RDNs) vary in their perceptions of cultural elements depending on years of professional experience. For example, the least experienced RDNs (average of 4.62 years) were more likely to perceive that beliefs about Mexican and American foods in general important for diabetes self-management compared to the highly experienced group of RDNs (average of 33.98 years). Additionally, RDNs who provided T2DM counseling to Mexican-Americans were more likely to fall in the least experienced group, be Certified Diabetes Educators, work in outpatient settings and provide individual counseling. With regards to cultural competency levels assessed, there were no differences assessed between the three experience levels RDNs were grouped in.The final aim examined how six T2DM intervention curricula incorporated cultural elements. The results of this content analysis showed that the main cultural elements incorporated were related to diet were food habits, food preferences or avoidances, acquisition and use of nutrition knowledge, beliefs about Mexican/cultural foods and general health beliefs about foods. Specific health beliefs and values commonly recognized as influential factors for self-management and healthcare seeking behaviors for Mexican-Americans were less likely to be addressed. However, overcoming barriers, general health beliefs about diabetes and family influences were incorporated in some of the curricula.Through this research, we identified that there is a demand for culture-specific cultural competency trainings among RDNs and that several tools are available to encourage dissemination of evidence-based findings such as integrating background information in diabetes self-management curricula and cultural competency training opportunities (such as professional development and higher education). Overall, these results suggest that culture-specific knowledge is not uniformly evident in nutrition therapy practice when Mexican-Americans who have T2DM. This may also be true for all healthcare professions working with this and other ethnic populations. Therefore, future research should focus on identifying opportunities for culture-specific cultural competency training, how these trainings transfer into better outcomes for patients, and finally, examining which and how cultural elements provide better behavior change outcomes in interventions.
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