Biocultural models, cultural consonance and salutogenesis in type 2 diabetes treatment; measuring the impact of symbol systems on health within a Mexican community
The project described here takes place in Guadalajara, Mexico in a major government sponsored health clinic. It examines the impact of social and cultural factors on clinical medical treatment with a focus on type 2 diabetes. The aim of the project is to understand the effects of culturally specified aspects of medical treatment on health outcomes. The approach to the problem is from cognitive biocultural anthropology, which emphasizes the interdependency of biology and culture. It was hypothesized that after controlling for clinical treatment, including diet, activity, and pharmaceutical consumption, that those who are able to implement culturally specified models of treatment in their own lives (cultural consonance) will have better diabetic outcomes such as lower BMI, controlled blood glucose, and greater overall well-being. A multi-stage research design, including logistic and least squares regression, facititated hypothesis testing. The project begins with cultural domain analysis including qualitative elicitation of local cultural models of treatment (n=57), followed by cultural consensus analysis (n=56). The project finishes with quantitative and comparative analyses through epidemiological survey with 85 diabetic patients. Physiological outcome measures were drawn from medical records. The local cultural model of treatment adheres closely to the biomedical model, but also includes influences from traditional medical belief systems and from the social system more generally. Diet was an especially salient aspect of the model. Survey results show an association between greater cultural consonance in the food-as-treatment model and lower BMI. Greater cultural consonance in the treatment domain was not associated with greater glucose control. Rather it was associated with poor control, which led to a reconsideration of glucose levels from an emic, patient-centered perspective. Glucose levels were re-conceptualized as disease gravity. In this sense, glucose predicts greater participation in the broadly conceived therapeutic model, but not necessarily more intensive participation in the clinical treatment regimen. Finally, greater cultural consonance in treatment predicts greater well-being. Results are discussed in relation to the research questions.