Herbs, Prayer, and Insulin: Use of Medical and Alternative Treatments by a Group of Mexican American Diabetes Patients

Data Collection

We conducted in-depth open-ended interviews following an interview guide of standardized questions. Patients were encouraged to answer in their own words with as much detail as they wished. To facilitate cross-case comparisons, every critical question was asked of all participants. The interviews were conducted in patients’ homes in the language of their preference, lasted approximately 2 hours each, and were tape-recorded and transcribed. The first author (LMH) performed translations from the original Spanish.

The interviews addressed the patients’ personal experiences with diabetes, self-care behaviors, and individual perceptions regarding their health status. Questions about their use of alternative treatments included: Have you ever used or heard of any other kinds of treatments for diabetes? Any home remedies or things like herbs or curanderos? Have you tried them? Do you think they help? Do you think that religion or your spiritual life can affect your health? Do you ever pray about your health or your diabetes? Do you think it helps?

Data Analysis

We indexed all field notes and transcripts by topic and established a filing and retrieval system. We then created a database with variables grounded in open-ended responses to relevant questions. We analyzed this data using SPSS software.⁵¹ We also established a method for displaying interview data, building initial matrices of blocks of text (quotations and summations) for each patient that included comments about treatment behaviors and evaluations of their effects. Next, we identified trends and patterns among cases, which we summarized into higher level matrices with the participants grouped by types and patterns of treatment.

We crosschecked all phases of analysis in conference sessions during which the research team reached consensus about applying coding categories and addressed any anomalies or discrepancies. Interrater reliability was established through a second researcher recoding 50% of the case material, validating consistency in coding and classification procedures.

Results

Patients ranged in age from 29 to 69 years with a mean age of 53.9 years. Like most patients in the public clinics from which they were recruited, they were mostly of low-income and low-educational levels, with nearly two thirds unemployed, a mean annual household income of approximately $12,500, and an average of 8.1 years of schooling. Approximately half of the sample chose to be interviewed in Spanish. Approximately half were men, half had diabetes for 6 years or longer, and half had good blood glucose control at the time of the interview. Classification of a participant’s level of glucose control was based on review of medical records from the past year. For glycosylated hemoglobin (Hb A1C), a level of 7.5% or lower was considered good, 7.6% to 10.0% was fair; and higher than 10.0% was poor. If an Hb A1C result was not available, the fasting glucose level was used, with lower than 180 mg/dL considered good, 180 mg/dL to 250 mg/dL fair, and higher than 250 mg/dL poor (Table 1).

Herbal Treatments

When asked if they knew of any treatments for diabetes besides diet, exercise, and medications, 84% of the participants (36/43) said they had heard ofusing herbs to treat the disease (Table 2). The herbs mentioned most often were nopal (prickly pear cactus), 39%; aloe vera, 31%; and nispero (loquat or chinese plum), 17%. However, more than a third of those who mentioned herbs named no specific herb but merely said they had heard herbs could be used (Table 3).

The nopal or prickly pear cactus (opuntia) is a very common plant in South Texas and is a common food item in the region. Its leaves are lightly cooked and mixed with eggs or eaten as a vegetable side dish. Some people in our study reported having increased these dietary uses of nopal as an adjunct to their treatment for diabetes. Others described making a licuado (a drink mixed in an electric blender) out of raw nopal leaves and water; some also added raw aloe vera to this mixture. Most people who described this preparation said they felt it had a positive effect on lowering blood sugar, but some said it had a bitter taste and did not continue to take it after trying it once or twice.

Nispero or loquat (eriobotrya japonica) is also a common plant of the region. It is a large shrub with long leathery leaves that produces clusters of sweet yellow fruit in the spring. Its leaves are brewed into a strong tea that some patients said they drank up to 3 times a day and found helped lower their blood sugar.

Frequency of Herb Use