Improving access to shared decision-making for Hispanics/Latinos with inadequately controlled type 2 diabetes mellitus

Abstract

Jaime A Davidson,1 Aracely Rosales,2 Alicia C Shillington,3 Robert A Bailey,4 Chris Kabir,3 Guillermo E Umpierrez51Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Rosales Communications, Philadelphia, PA, USA; 3EPI-Q, Inc., Oakbrook, IL, USA; 4Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA; 5Division of Endocrinology and Metabolism, Emory University, Atlanta, Georgia, GA, USAPurpose: To describe the cultural and linguistic adaptation and Spanish translation of an English-language patient decision aid (PDA) for use in supporting shared decision-making in Hispanics/Latinos with type 2 diabetes mellitus (T2DM), a group at a high risk for complications.Patients and methods: A steering committee of endocrinologists, a primary care physician, a certified diabetes educator, and a dietician, each with extensive experience in providing care to Hispanics/Latinos was convened to assess a PDA developed for English-speaking patients with T2DM. English content was reviewed for cultural sensitivity and appropriateness for a Hispanic/Latino population. A consensus-building process and iterative version edits incorporated clinician perspectives. The content was adapted to be consistent with traditional Hispanic/Latino cultural communication precepts (eg, avoidance of hostile confrontation; value for warm interaction; respect for authority; value of family support for decisions). The PDA was translated by native-speaking individuals with diabetes expertise.Results: The PDA underwent testing during cognitive interviews with ten Spanish-speaking Hispanics/Latinos with T2DM to ensure that the content is reflective of the experience, understanding, and language Hispanic/Latino patients use to describe diabetes and treatment. Content edits were made to assure a literacy level appropriate to the audience, and the PDA was produced for online video dissemination.Conclusion: High-quality, well-developed tools to facilitate shared decision-making in populations with limited access to culturally sensitive information can narrow gaps and align care with individual patient preferences. A newly developed PDA is available for shared decision-making that provides culturally appropriate treatment information for inadequately controlled Hispanics/Latinos with T2DM. The impact on the overall health of patients and care management of T2DM requires further study.Keywords: patient decision aid, language adaptation, Hispanic, decision making, type 2 diabetes