Adapting the PDA for Spanish-Speaking Patients

According to a 2015 report, Hispanics and Latinos are estimated to represent 17.7% of the total US population.9 This population is expected to increase to 22.8% of the US population by 2035.9 Hispanics are the largest racial/ethnic minority population in the US10 and at higher risk for diabetes-associated morbidity and mortality and poorer glycemic control, compared to the general US population and non-Hispanic/Latino whites.11 This disturbing disparity may be explained by several factors, including differences in access to quality healthcare and socioeconomic cultural factors.11

A group of researchers has adapted the PDA for Hispanic/Latino patients with T2DM by creating “culturally and linguistically aligned PDAs that respect the socio-demographics, cultural values, beliefs, and practices of the intended audience.”11


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A steering committee consisting of endocrinologists, a primary care physician, a certified diabetes educator, and a dietician – each with experience in providing care to the Hispanic/Latino population – adapted the content of the PDA developed for English-speaking patients with T2DM, taking into account cultural sensitivity and cultural appropriateness. Native Spanish-speaking individuals with diabetes expertise then translated the PDA.

The Spanish version PDA was tested during cognitive interviews with 10 Spanish-speaking Hispanics/Latino adults with T2DM (five male, five female, ranging in age from 31–66 years), who were asked to comment on clarity of content and consistency with their diabetes experience. Participants hailed from Argentina, Ecuador, Guatemala, Mexico, Nicaragua, Puerto Rico, and Spain. Nine were current full-time residents of the US, 90% had at least some high school education, and one was a college graduate. Patient interviews were conducted by a professional Spanish interpreter.