The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms

Adrienne Martinez-Hollingsworth; Nalo Hamilton; Kristen Choi; MarySue Heilemann

doi:10.1016/j.diabres.2021.108787

The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms

Diabetes Res Clin Pract. 2021 May:175:108787. doi: 10.1016/j.diabres.2021.108787. Epub 2021 Apr 9.

Authors

Adrienne Martinez-Hollingsworth¹, Nalo Hamilton², Kristen Choi³, MarySue Heilemann⁴

Affiliations

¹ University of California, Los Angeles, 1100 Glendon Ave. Suite 900, Los Angeles, CA, USA. Electronic address: asmartinez@mednet.ucla.edu.
² University of California, Los Angeles, 5-659 Factor Building, Los Angeles, CA, USA. Electronic address: nhamilton@sonnet.ucla.edu.
³ University of California, Los Angeles, Factor Building 3-238, Los Angeles, CA, USA. Electronic address: krchoi@ucla.edu.
⁴ University of California, Los Angeles, Factor Building: 5-252, Los Angeles, CA, USA. Electronic address: mheilema@sonnet.ucla.edu.

PMID: 33845050
DOI: 10.1016/j.diabres.2021.108787

Abstract

Aims: The purpose of this study was to examine how older Latina women emotionally experience type 2 diabetes mellitus and interactions with care providers using a grounded theory approach.

Methods: Sixteen English-speaking, Latina women, 60 years and older, diagnosed with type 2 diabetes mellitus and experiencing symptoms of depression or anxiety participated in 21 phone interviews guided by a semi-structured interview guide. Data was collected and analyzed using Grounded Theory methodology; theoretical sampling was used to achieve data saturation.

Results: Participant data informed the creation of a theory, The Secret Self-Management Loop, with four interconnected phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and 4) engaging in secret self-management. These phases reflected participants' lost trust in their providers and the medical system, resulting in undisclosed self-management strategies that complicated clinical management of their type 2 diabetes mellitus diagnosis. Primary sources of loss of trust were interactions that lacked empathy or caused them to question their providers' motivation.

Conclusion: The Secret Self-Management Loop negatively influences patient disclosure and distorts providers' ability to adequately render care for this group.

Keywords: Aging; Depression; Latina; Mistrust; Type 2 diabetes mellitus.

MeSH terms

Aged
Diabetes Mellitus, Type 2
Female
Grounded Theory*
Hispanic or Latino
Humans
Male
Mental Health / standards*
Middle Aged
Research Design
Self-Management