Week 6 tiff
Mentors
annotated-CulturallyTailoredDiabetesEducationforCubanAmericans3.PDF.PDF
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Alternate Intervention Paper: Culturally Tailored Diabetes Education for Cuban
Americans
Tiffany Williams
Herzing University
NU700
4/5/2025
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Alternate Intervention Paper: Culturally Tailored Diabetes Education for Cuban
Americans
In contemporary health care, professional nurses play important bridges between practice
and evidence to apply evidence-based interventions to confront persistent health inequities. One
such essential issue is a lack of proper self-management of type 2 diabetes among Cuban
Americans, who are disproportionately plagued by system-level barriers like food habits due to
culture, linguistic barriers, and socioeconomic constraints (Volker & Becker, 2021). These
determinants are responsible for poorer glycemic control and higher diabetes complications risks
compared to non-Hispanic whites. Because nurses are on the ground level for chronic disease
management and patient education, they are ideally positioned to utilize and promote culturally
tailored interventions closing these disparities. This essay returns to the practice dilemma of
Cuban American diabetes self-care, first examined in the Unit 4 assignment, and locates an
evidence-based intervention—the most promising remedy found to be a culturally adapted
diabetes education program delivered by bilingual community health workers (CHWs). An
analysis of four studies notes the effectiveness of this intervention in improving health outcomes.
The article concludes with a discussion of the overall implications for evidence-based practice in
eliminating health disparities.
Review of the Practice Problem
The analysis of Unit 4 revealed three major obstacles to efficient diabetes self-care management
among Cuban Americans:
1. Cultural Dietary Habits: The traditional diets in Cuba are high in consumption of refined
carbohydrates (i.e., rice, plantains, and bread), which conflict directly with diabetes
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medical nutrition therapy (Maldonado et al., 2022). The patients resist changes in diet due
to strong cultural links between food and identity.
2. Health Literacy and Language Barriers: Limited proficiency in English restricts access to
diabetes educational resources and impedes interaction with healthcare providers. Failure
to comprehend instructions—e.g., insulin dosing or carbohydrate counting—leads to
dangerous mismanagement (Escobedo et al., 2023).
3. Western Medicine Distrust: Past marginalization and cultural dispositions toward home
remedies (e.g., herbal tea) prevent early professional intervention, exacerbating
complications like neuropathy and retinopathy (Cruz et al., 2022).
Literature Review of Selected Intervention
A culturally tailored diabetes self-management program through bilingual community
health workers (CHWs) has been shown as an effective intervention to improve Cuban American
and other Latino subgroup members' self-care of diabetes. Research by Volker & Becker (2021)
highlights the importance of culture-adapted dietary guidelines, where Cuban Americans struggle
to alter traditional eating habits such as overconsumption of white rice and red meat, which are
associated with insulin resistance (Maldonado et al., 2022). CHWs of the same linguistic
backgrounds and similar patient cultural affiliations enhance confidence and comprehension by
providing education within Cuban dialect or Spanish, closing the gap imposed by limited English
proficiency (Escobedo et al., 2023). Involvement of families contributes as well because this
enhances behavior change, with the real experiences of CHWs placing patients into the limelight
(Cruz et al., 2022). These results indicate that the inclusion of CHWs in diabetes care can resolve
structural inequities, enhance health literacy, and support sustainable self-management routines.
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Synthesis of Evidence
The results validate four evidence-based predictors of effective diabetes interventions in
Cuban American populations: (1) Cultural Adaptation—cultural comfort gained via adapted food
recommendations (e.g., cauliflower rice replacing white rice) guarantees adherence (Maldonado
et al., 2022); (2) Language Concordance—attention to culturally spoken Spanish and regional
dialect languages improves understanding and retention (Escobedo et al., 2023); (3) Trust-
Building—being community-based yet medically respected professionals, CHWs surmount
medical suspicion through reconciling cultural values with health messaging (Cruz et al., 2022);
and (4) Family Involvement—engaging family members in educational sessions reinforces
behavior change in the long term (Volker & Becker, 2021). These factors combined promote
intervention acceptability and effectiveness.
Implementation in Practice
To implement a diabetes program led by CHWs, health systems need to: (1) Partner with
Cuban American community-based organizations to recruit and train bilingual CHWs; (2) Design
targeted education materials with culturally relevant food changes (e.g., healthier alternatives to
Cuban staples); and (3) Eliminate structural barriers through Medicaid lobbying for CHW
services reimbursement and grant funding procurement. Potential pitfalls are provider reluctance
to integrate CHWs and funding issues, but pilot projects yield a 3:1 return on investment as
hospitalization rates decrease (Peek et al., 2021).
Conclusion
Diabetes self-management disparities among Cuban Americans reflect broader systemic
health inequities in access to care and cultural sensitivity. Culturally tailored, CHW-facilitated
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interventions are a scalable solution, particularly with policy initiatives (e.g., insurance
reimbursement for CHWs) and collaboration with community organizations. Long-term impacts
need to be tested through implementation model use such as the Knowledge-to-Action model in
future research. Through structural barrier recognition and cultural humility, healthcare systems
can facilitate health equity among marginalized Latino populations
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References
Cruz, M. L., Christie, S., Allen, E., Meza, E., Nápoles, A. M., & Mehta, K. M. (2022).
Traditional healers as health care providers for the Latine community in the United
States, a systematic review. Health equity, 6(1), 412-426.
https://scholar.google.com/scholar?output=instlink&q=info:boDbmUIkvEsJ:scholar.goog
le.com/&hl=en&as_sdt=0,5&as_ylo=2021&scillfp=1955883426044218443&oi=lle
Escobedo, L. E., Cervantes, L., & Havranek, E. (2023). Barriers in healthcare for Latinx patients
with limited English proficiency—a narrative review. Journal of general internal
medicine, 38(5), 1264-1271. https://link.springer.com/content/pdf/10.1007/s11606-022-
07995-3.pdf
Maldonado, L. E., Sotres-Alvarez, D., Mattei, J., Daviglus, M. L., Talavera, G. A., Perreira, K.
M., ... & Albrecht, S. S. (2022). A Posteriori dietary patterns, insulin resistance, and
diabetes risk by Hispanic/Latino heritage in the HCHS/SOL cohort. Nutrition &
Diabetes, 12(1), 44. https://www.nature.com/articles/s41387-022-00221-3.pdf
Volker, D. L., & Becker, H. (2021). Cuban Americans with Type 2 Diabetes: Describing Self-
Management Decision Making Using an Empowerment Framework.
https://www.academia.edu/download/76530394/CUEVAS-DISSERTATION-2013.pdf
