Rethinking the Role of Culture in Health Research

Latino adults in the US face a disproportionately high risk of type 2 diabetes, with wide disparities across socioeconomic, immigration, and citizenship status.While intensive lifestyle interventions have shown promise for diabetes prevention and control, these programs have been less successful for Latino populations.To address this issue, Perreira and colleagues 1 used qualitative interviews to explore perceived barriers and facilitators to lifestyle change in the National Diabetes Prevention Program among Latino adults.The authors reported that a variety of cultural barriers shape diabetes prevention efforts in Latino populations, such as internalized cultural biases, traditional gender roles, and family dynamics.They also highlight facilitators such as family support and culturally and linguistically aligned program supports, including community health workers, that enhanced participants' experiences.By illuminating the lived experiences of predominantly Spanish-speaking Latinos, Pereira et al 1 seek to inform more effective intervention strategies.However, the study 1 illustrates a broader tension in health research: the reliance on cultural explanations for health behaviors and outcomes among immigrant and racialized groups. 2 The authors 1 interpret participants' descriptions of gender roles, health-seeking behaviors, and family obligations largely through commonly invoked Latino cultural constructs such as familismo (eg, prioritization of family values), machismo and marianismo (eg, traditional gender roles), respeto (eg, respect and deference), and personalismo (eg, valuing person-centered connected and trust).These constructs are familiar within Latino health research and are often used to explain both barriers to and facilitators of behavior change, 3 yet their use raises important questions about how culture is defined, operationalized, and situated relative to structural conditions in health research about Latino populations and other groups for whom culture is often invoked. 4ltural explanations for health outcomes typically posit that shared values, norms, and beliefs shape individual behaviors, such as diet, physical activity, health care utilization, and ultimately health.