MPH 520 Week 3 Cultural Factors in Population Health Example

Tortillas, Family Tables and a Grandmother's Advice: Cultural Factors in Diabetes Prevention for Hispanic Families in a Southern Colorado Community

[Student Name]

University of Phoenix

MPH/520: Social and Behavioral Aspects of Public Health

Week 3 Assignment

[Instructor Name]

[Date]

The county health department, the families interviewed and the program changes are composites written for a model paper; research findings come from the sources cited.

A promotora who worked with the composite southern Colorado health department's diabetes prevention program brought the coordinator a stack of recipe cards from the curriculum. She said the recipes read like a hospital menu: baked fish, quinoa salads, steamed vegetables. Families she visited cooked beans, chile, tortillas and posole, and no one would make these recipes. Her comment led the department to examine how culture shaped diabetes prevention among the Hispanic families who made up about 40% of its program referrals. This paper presents that analysis.

A Diverse Community

Hispanic residents of the county are not one group. Many descend from families who have lived in southern Colorado for generations, some since before it was part of the United States, and speak mainly English. Others are recent immigrants from Mexico and Central America who speak Spanish. They differ by age, income, religion and experience. Any cultural analysis must start from this diversity.

Listening First

The department held six listening sessions, three in Spanish and three in English, at churches and a community center, and interviewed 20 families referred to the program. The findings below come from what they said.

Food as Family and Celebration

Food was central to family life and identity. Meals were shared across generations, and refusing food prepared by a mother or grandmother could feel disrespectful. Celebrations such as baptisms and quinceañeras revolved around traditional dishes. Participants did not want to give up their food; they wanted to know how to make it healthier without losing its meaning.

Family Decision Making

Health decisions were often family decisions. Women usually cooked and managed family health, while men sometimes resisted changes to meals. A single participant changing diet alone rarely lasted; changes that included the family did.

Faith and Beliefs About Illness

Faith was important to many. Some older participants expressed a belief that diabetes was fate or God's will, which could reduce motivation for prevention, while others saw caring for health as a religious duty. Churches were trusted gathering places for every generation.

Language and Communication

Recent immigrants preferred Spanish materials and Spanish-speaking staff. Long-established families preferred English but valued staff who understood their community. Both groups preferred personal conversations to printed handouts.

Experiences With Health Care

Some participants described feeling rushed or judged by clinicians, or unwelcome because of language or immigration status. These experiences reduced trust and made them reluctant to join programs run by official agencies.

Generational Differences

Younger participants often ate differently from their parents, relying more on fast food and convenience meals than on traditional cooking. For them, the challenge was less changing traditional dishes than finding time to cook at all. Grandmothers, by contrast, often held the family's cooking knowledge and had great influence on what the family ate. The program learned to engage both.

Strengths in the Culture

The analysis also found strengths: strong family networks that could support change, traditional diets rich in beans, vegetables and chile, a habit of walking together after church and community organizations with deep roots. A program that builds on strengths works better than one that treats culture only as a barrier.

Separating Culture From Economics

Not every barrier was cultural. Cost of fresh food, shift work and lack of time were economic and structural, and they affected families of every background. The department took care not to label economic barriers as cultural preferences.

Evidence on Culturally Appropriate Education

Adapting programs to culture has evidence behind it. A Cochrane review of 33 trials involving 7,453 participants found that culturally appropriate health education for people in ethnic minority groups with type 2 diabetes improved HbA1c by 0.4 percentage points at three months and 0.5 at six months compared with usual care, based on high-quality evidence (Attridge et al., 2014). Adapting a program to people's lives is not a courtesy; it changes blood sugar.

Evidence on Community Health Workers

Community health workers from the same community extend these effects. In a randomized trial among African American and Latino adults with type 2 diabetes, a community health worker intervention reduced mean HbA1c from 8.6% to 7.8% at six months, an adjusted change of 0.8 percentage points, with no change in the control group, and improved participants' understanding of diabetes (Spencer et al., 2011).

Evidence From a Latino Prevention Program

Prevention programs can be adapted as well. A community-based diabetes prevention program for Latino adults at high risk, most with less than a high school education, retained 94% of participants at one year and produced modest weight loss of 2.5 pounds compared with a gain of 0.63 pounds in usual care, along with improvements in HbA1c, insulin resistance and dietary fat (Ockene et al., 2012).

Change One: Recipes From Family Kitchens

The department asked families and a local cook to adapt traditional recipes: beans cooked without lard, whole-wheat or corn tortillas, green chile stews with more vegetables and baked rather than fried dishes. The new recipe book uses dishes families already make.

Change Two: Family Sessions

Two of the program's sessions now invite spouses and adult children, focusing on family meals and shopping together.

Change Three: Promotoras

Promotoras co-lead groups, visit homes and follow up by phone. Their shared background builds trust and makes the program feel like the community's own.

Change Four: Churches and Community Centers

Groups meet at three churches and a community center, at times that work for families, in Spanish and in English.

Welcoming Everyone

The program removed questions about immigration status from its forms, trained staff to greet families in their preferred language and posted a statement that services are open to all residents. Families who had avoided official programs because of past experiences began to enroll.

Change Five: Respecting Beliefs

Rather than challenging beliefs about fate, promotoras frame prevention as caring for family and faith, and invite a pastor to speak at one session.

Addressing Economic Barriers Too

Alongside cultural changes, the department added food bank partnerships and weekend sessions for shift workers, recognizing that culture and economics both matter.

Staff Reflection

Staff who had assumed that low enrollment reflected lack of interest came to see that the program itself had signaled it was not designed for these families. Several asked for training in cultural humility, which the department added for all program staff, taught partly by promotoras.

Measures

The department will track enrollment and retention among Hispanic participants, weight change, participant satisfaction and whether families report using the adapted recipes.

Conclusion

A promotora's comment about recipe cards opened a deeper look at culture. Food as family, shared decisions, faith, language and past experiences with care all shaped diabetes prevention, while cost and work shaped it too. Evidence that culturally appropriate education and community health workers improve outcomes, and that adapted prevention programs can retain participants, supported changes designed with families rather than for them.

References

Attridge, M., Creamer, J., Ramsden, M., Cannings-John, R., & Hawthorne, K. (2014). Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 2014(9), CD006424. https://doi.org/10.1002/14651858.CD006424.pub3

Ockene, I. S., Tellez, T. L., Rosal, M. C., Reed, G. W., Mordes, J., Merriam, P. A., Olendzki, B. C., Handelman, G., Nicolosi, R., & Ma, Y. (2012). Outcomes of a Latino community-based intervention for the prevention of diabetes: The Lawrence Latino Diabetes Prevention Project. American Journal of Public Health, 102(2), 336-342. https://doi.org/10.2105/AJPH.2011.300357

Spencer, M. S., Rosland, A.-M., Kieffer, E. C., Sinco, B. R., Valerio, M., Palmisano, G., Anderson, M., Guzman, J. R., & Heisler, M. (2011). Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: A randomized controlled trial. American Journal of Public Health, 101(12), 2253-2260. https://doi.org/10.2105/AJPH.2010.300106