title: Opportunities for involving men and families in chronic disease management: a qualitative study from Chiapas, Mexico.
abstract: BACKGROUND
  A healthy lifestyle intervention was implemented in primary care health centers in urban parts of Tuxtla Gutiérrez, Chiapas, Mexico with an aim of reducing cardiovascular disease risk for patients with type 2 diabetes and/or hypertension. During implementation, research questions emerged. Considerably fewer men participated in the intervention than women, and an opportunity was identified to increase the reach of activities aimed at improving disease self-management through strategies involving family members. A qualitative study was conducted to identify strategies to involve men and engage family members in disease management and risk reduction.
  
  
  METHODS
  Nine men with hypertension and/or type 2 diabetes with limited to no participation in disease self-management and health promotion activities, six families in which at least one family member had a diagnosis of one or both conditions, and nine health care providers from four different government health centers were recruited for the study. Participants took part in semi-structured interviews. During interviews with families, genograms and eco-maps were used to diagram family composition and structure, and capture the nature of patients' relationships to the extended family and community resources. Transcripts were coded and a general inductive analytic approach was used to identify themes related to men's limited participation in health promotion activities, family support and barriers to disease management, and health care providers' recommendations.
  
  
  RESULTS
  Participants reported barriers to men's participation in chronic disease management and healthy lifestyle education activities that can be grouped into two categories: internal and external factors. Internal factors are those for which they are able to make the decision on their own and external factors are those that are not related solely to their decision to take part or not. Four primary aspects were identified related to families' relationships with disease: different roles within the family, types of support provided to patients, the opportunity to prevent disease among family members without a diagnosis, and - in some cases - lack of family support or stress-induced by other family members. There was an overlap in recommended strategies for engaging men and family members in chronic disease management activities.
  
  
  CONCLUSIONS
  There is an opportunity to increase the reach of interventions aimed at improving disease self-management by engaging men and family members. The proposed strategies presented by patients, family members, and providers have implications for health education and service provision at primary care health centers and for future research.
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. mfort@incap.int.|Department of Family Medicine, University of Colorado - Denver, Denver, CO, USA. mfort@incap.int.
authors.forename: Meredith P
authors.initials: MP
authors.lastname: Fort
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. maricruz.castro@unicach.mx.|School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico. maricruz.castro@unicach.mx.
authors.forename: Maricruz
authors.initials: M
authors.lastname: Castro
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. superarleth@hotmail.com.|School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico. superarleth@hotmail.com.
authors.forename: Liz
authors.initials: L
authors.lastname: Peña
authors.affiliation: School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico. checo_31_90@hotmail.com.
authors.forename: Sergio Hernán
authors.initials: SH
authors.lastname: López Hernández
authors.affiliation: School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico. arreola-19882011@hotmail.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Arreola Camacho
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. mramirez@incap.int.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramírez-Zea
authors.affiliation: INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. homero@rand.org.|RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. homero@rand.org.|Hospital Infantil de México, "Dr. Federico Gómez", Mexico City, Mexico. homero@rand.org.
authors.forename: Homero
authors.initials: H
authors.lastname: Martínez
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D002908:Chronic Disease; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005190:Family; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008571:Men; D008800:Mexico; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012648:Self Care; D014505:Urban Population / Q000706:statistics & numerical data