We scored the level of biomedical activity as follows: Three points were given for taking medications as prescribed, for following a prescribed diet, and for exercising regularly. Two points were given for taking medication but not precisely as prescribed, for following a diet irregularly, and for exercising intermittently. One point was given for having stopped taking medication, for not instituting any dietary changes, and for not exercising.
We scored the level of alternative treatment activity as follows: Three points were given for identifying 2 or more alternative treatments, for currently using an alternative treatment, and for positively evaluating the effect of an alternative treatment on diabetes. Two points were given for listing at least one alternative treatment, for reporting either past or future but not current use of such treatments, and for neutrally evaluating the effectiveness of alternative treatments. One point was given for listing no specific alternative treatments, for not having tried any and not planning to do so, and for negatively evaluating the impact of alternative therapies.
Activity scores for each type of treatment ranged from 3 to 9. Overall activity level was classified as follows: 3 to 4.5 was low, 4.6 to 7.5 was medium, and 7.6 to 9 was high.
The scores for level of activity in biomedical and alternative treatments are summarized in Table 4. Very few patients were inactive in pursuing biomedical treatment, while nearly a third were very actively pursuing it. Although the majority were doing so imperfectly, their interest and intention to follow biomedical regimens was clear. In contrast, the level of involvement with alternative treatments was notably less pronounced. Nearly half were classified as having low activity in alternative treatments, and the rest were divided between high and medium activity levels.
If alternative and biomedical treatment strategies were in competition for these patients, one would expect to see a strong negative correlation between these variables. However, this was not the case (Figure). In fact, the correlation coefficient of r=.155 shows a small positive correlation. That is, people that are active in alternative treatments are somewhat more likely to also be active in biomedical treatment. Furthermore, the paired Student t test shows that, on average, individuals have .338 lower alternative activity scores than biomedical scores and that this is a statistically significant difference with a 2-tailed P value of .017.
Thus, rather than using alternative treatments instead of biomedical treatments, we see the opposite: Our participants were more likely to choose biomedical treatments over alternative methods. For those individuals who were highly engaged in alternative treatments, there was a tendency to also be quite active in biomedical treatments. It seems that patients who are not very interested in biomedical treatments for their diabetes are not very interested in any kind of care. Those who are very interested in alternative treatments seem to be involved in a process of actively seeking solutions to their diabetes, drawing on whatever resources they encounter. The following quotes illustrate this attitude:
“I’ve always gone with what the doctors give me. And now I just want to get off insulin. I’m tired of it. And I’m gonna try as much as I can, whatever they tell me.”
“Herbs are good, but they have to be under medical assistance with an MD, so he can prescribe the medication you need to help you along.”
Discussion
Our study is unique because we not only documented the variety of alternative treatments a group of Mexican American patients were aware of for type 2 diabetes, but also explored how they thought about and used these treatments. We found that although most of these patients could list a variety of herbal treatments for the disease, few reported regularly using them, and few said they found them very effective. Many who did use herbal treatments said they did so only occasionally, and none said they had replaced medical regimens with alternative treatments. None had used curanderos for their diabetes, and although many prayed about their illness, this was done in conjunction with medical treatment, not in its place.
Although the understanding of and compliance with conventional diabetes regimens of many of these patients may be less than optimal,52-54 we found no reason to attribute these limitations to their use of alternative treatments and their religious beliefs and practices. Such approaches are clearly viewed by these patients as supplemental to biomedicine and are not given primary emphasis. Most expressed the attitude that alternative therapies may not help much but probably will not hurt, as long as they are used in conjunction with what medical providers recommend.