Journal of Immigrant and Minority Health

, Volume 18, Issue 6, pp 1392–1403 | Cite as

Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants

  • Cheryl A. Smith-MillerEmail author
  • Diane C. Berry
  • Darren DeWalt
  • Cass T. Miller
Original Paper


This article describes the quantitative findings of a mixed-methods study that examined the relationship among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes self-management among recent Spanish-speaking, limited English proficient immigrants to the US. This population is at risk for both a higher incidence of disease and increased barriers to successful disease management compared to the general US population. Distinguishing aspects of this study compared to the available literature are the comprehensive nature of the data collected, the theoretical component, and the analysis and modeling approach. Social cognitive theory provides the framework for the study design and analysis. An innovative community-based recruiting strategy was used, a broad range of physiological measures related to health were observed, and instruments related to knowledge, self-efficacy, and healthy lifestyle behaviors were administered orally in Spanish to 30 participants. A broad range of statistical analysis methods was applied to the data, including a set of three structural equation models. The study results are consistent with the importance of education, health knowledge, and healthy lifestyle practices for type 2 diabetes self-management. With the usual cautions associated with applying structural equation modeling to modest sample sizes, multiple elements of the posited theoretical model were consistent with the data collected. The results of the investigation of this under-studied population indicate that, on average, participants were not effectively managing their disease. The results suggest that clinical interventions focused on improving knowledge, nutrition, and physical activity, reducing stress, and leveraging the importance of interpersonal relations could be effective intervention strategies to improve self-management among this population.


Diabetes management Health literacy Self-efficacy Knowledge Immigrants Structural equation modeling 



This study was supported by grants from the Academy of Medical-Surgical Nurses, North Carolina Nurses Association—Triangle Region, and Sigma Theta Tau—Alpha Alpha Chapter. The UNC School of Nursing Bio-behavioral Laboratory and the Family Partners provided equipment for the physiological measures.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Cheryl A. Smith-Miller
    • 1
    • 2
    Email author
  • Diane C. Berry
    • 2
  • Darren DeWalt
    • 3
  • Cass T. Miller
    • 4
  1. 1.Nursing Quality and ResearchUniversity of North Carolina HospitalChapel HillUSA
  2. 2.School of NursingUNC-CHChapel HillUSA
  3. 3.School of MedicineUNC-CHChapel HillUSA
  4. 4.UNC Gillings School of Global Public HealthUNC-CHChapel HillUSA

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