Type 2 diabetes disproportionately affects Hispanics, a rapidly growing population and now the largest minority in the United States. Diabetes prevalence and mortality are two to five times higher in this population than in other ethnic groups (1,2). The prevalence of diabetes in the United States–Mexico border region (15.7%), where the population is predominantly of Mexican descent, is almost twice state (8.3%) and national (9.6%) levels (3,4). A recent study conducted by the Pan American Health Organization reports that the diabetes mortality rate in the Texas–Mexico border region (31.9%) is higher than in the state (24.9%) and in the nation (24.9%) (5).

Some studies suggest that Hispanics have a genetic predisposition to diabetes (6). Nonetheless, the potential of lifestyle changes in diet and physical activity to prevent or delay the onset of type 2 diabetes is well documented (7,8), and studies report low levels of physical activity among Hispanics (9-12). The 2005 Behavioral Risk Factor Surveillance System reports that nationally more Hispanics (56.3%) than non-Hispanic whites (48.9%) fail to meet physical activity recommendations (9). Other studies that include Mexican American women show that this Hispanic subgroup is less likely than any other ethnic subgroup to engage in leisure-time physical activity (10,11). In Texas, more Hispanics (34.5%) than non-Hispanic whites (10.4%) or African Americans (24.8%) are physically inactive. Percentages are higher in the easternmost part of the Texas–Mexico border, where 40.5% of Hispanics and 24% of non-Hispanic whites report high levels of inactivity (12).

Research shows that adults with type 2 diabetes tend to have low levels of physical activity, and national data and research studies indicate that Hispanics with type 2 diabetes are more sedentary than are their counterparts in other ethnic subgroups (13,14). Another study found higher levels of physical inactivity among Mexican Americans with type 2 diabetes (39%) than among non-Hispanic whites (34%) or African Americans with the disease (38%) (15). Despite evidence of the benefits of physical activity, little is known about the motivators and barriers to this behavior among Mexican Americans with type 2 diabetes.

Overall, Mexican Americans account for more than two thirds (66.9%) of Hispanics in the United States. Almost 11 million Mexican Americans are foreign born (39.9%); more than half of these (59.1%) migrated to this country after 1990 (16). Our study, conducted during 2005–2006, examines perceptions of physical activity and identifies motivators and barriers to physical activity among Mexican American adults with type 2 diabetes who live in the Lower Rio Grande Valley (the Valley), a four-county area in the easternmost region of the Texas–Mexico border. This rapidly growing population is closely integrated with Mexico, culturally, socially, and economically (17).

Currently, one million people, almost half the population of South Texas, live in the Valley (18). By 2010, the Valley's population is expected to increase by 27.8%, a higher percentage than in the state (16.0%) and the nation (9.6%) (19,20). Most Valley residents are of Mexican descent (87%); Spanish is spoken in three quarters of homes; 26% of Valley residents are foreign born (compared with 14% statewide and 11% nationally). The Valley fares worse in education, health insurance, and income than do Texas and the nation (18,21,22). Two thirds of individuals younger than 25 years of age have less than a 9th-grade education. Access to medical care is limited, and the major metropolitan areas of the Valley rank last in the nation in per capita income (18,22).

This study used a qualitative research design employing six focus groups of Mexican Americans who have type 2 diabetes and live in the Valley. Researchers used a convenience sampling method to select and recruit participants from one of the Valley's four counties. Community-based organizations and community health centers provided referrals. Individuals who agreed to participate were systematically screened for eligibility and had to be 1) aged 30–55 years; 2) diagnosed with type 2 diabetes at least one year before the study (self-reported); 3) without a diagnosis of a cardiovascular disease that would be worsened by exercise and would usually require supervision in a cardiac rehabilitation program; and 4) willing to participate in the study. The Institutional Review Board of Texas A&M University granted permission to conduct the study.

Thirty-nine individuals attended a total of six focus groups. All participants received the same standardized question guide on definitions of physical activity, preferred types of physical activity, motivators and barriers to physical activity, and concepts of culturally sensitive interventions. At the beginning of each focus group, researchers asked participants to read and, if they agreed to participate, to sign a consent form. Researchers read the consent form to some participants with low literacy skills. Focus groups were conducted in English or Spanish, depending on the language preference of participants. Each focus group lasted approximately 60 to 90 minutes, after which participants received a stipend and were personally thanked for their attendance. At the end of the group discussion, participants completed a written questionnaire on their demographic characteristics.

A team of Mexican American graduate students fluent in Spanish and English transcribed focus group discussions from audiotape. Five of the six transcriptions were written in Spanish to maintain the integrity of participants' responses. Only one focus group was conducted in English. Researchers removed all subject identifiers to protect the anonymity of participants and imported the transcripts into QSR N6 (QSR International Pty Ltd, Melbourne, Australia), a software program that codes and manages textual data.

Bilingual Mexican American members of the research team systematically reviewed and coded the transcripts and identified emerging themes. All team members had expertise in border studies related to Mexican Americans and a strong background in physical activity. Researchers based their data analysis on the focus group analysis principles of Morgan and Krueger (23,24). The research team identified, coded, and analyzed key words and emerging themes that indicated participants' issues and concerns. In cases of disagreement about key words or themes during the coding process, the team discussed the issue until reaching a consensus. If no consensus emerged, the principal investigator's decision prevailed.

Table 1 presents demographic characteristics of the study sample. Of the 39 participants, 34 (87%) were women and 21 (51%) had less than a high school education. A majority of participants were born in Mexico but had lived in the United States for more than 10 years.

This qualitative study of Mexican American adults who have type 2 diabetes and live in the Valley reveals ways in which this population conceptualizes physical activity, their preferred types of activities, their motivators and barriers to becoming more physically active, and components of their ideal program for promoting physical activity.

Our finding that the study population has a broad perspective of the concept of physical activity resonates with previous research (25,26). Eyler et al (1999) have shown that Hispanic women meet recommendations for physical activity when activities other than those performed during leisure time are examined (27). Other research has shown that Hispanic women engage in significantly more home- and work-related physical activity than do non-Hispanic whites (28).

These results have several research implications. First, further research with Mexican Americans with type 2 diabetes who live on the border with Mexico must emphasize the importance of assessing home- and work-related physical activities. Health benefits associated with these activities should also be examined. Most studies exploring such associations have been conducted mainly with non-Hispanic whites and have been cross-sectional in design, at best (29,30). Second, further research should test the validity and reliability of measurements quantifying moderate and vigorous levels of activity among Mexican Americans living in the border region. In future research, screening tools to identify baseline levels and to track the success of interventions in this population should incorporate an objective, multidimensional scale of physical activity that includes leisure-time, home-, and work-related activities. The use of accelerometers (31,32) could be examined to address the limitations of objective measurements of physical activity in this minority population.

Previous studies support our findings on main motivators for physical activity (33-35). Our findings related to barriers, however, differ from those of previous studies. Whereas earlier studies found that 1) the belief that physical activity is only for the young (34) and 2) not having friends (35) were the main impediments to physical activity, the barriers identified in our study were mostly environmental. This discrepancy may arise from the difference in study groups: previous studies focused on elderly Hispanics or other Hispanic subgroups that did not have type 2 diabetes or did not reside in the Texas–Mexico border region. Another intriguing aspect of our findings is that although a body of quantitative research examines environmental influences on physical activity, no studies with Hispanics have found significant associations between the two (36-39). Our study underlines the relevance of the environment to physical activity in the study population and suggests the need for continued research to determine environmental correlates in the Hispanic subgroup living on the Texas–Mexico border.

Findings on the ideal physical activity program for our study group are consistent with previous studies with elderly Hispanics (34,35). Because walking is the preferred type of physical activity in our sample, an intervention for this population should promote strategies to make walking a lifestyle behavior. Although walking is relatively easy and inexpensive, our study indicates that environmental factors must be addressed to assure the success of any walking program in the border region. The feasibility of, and adherence to, a walking program may depend on having adequate physical and social environments. Policymakers and other health professionals in the border region should advocate not only for programs that promote culturally sensitive interventions but also for policies that make neighborhoods environmentally suitable for physical activity.

Although the generalizability of a qualitative study such as ours is limited, the methodology used can provide insight into a range of meanings offered by participants. As the first study that explores perceptions of physical activity among Mexican Americans with type 2 diabetes who live in the Texas–Mexico border region, this study makes a valuable contribution to the existing literature, despite its limitations. Findings from the study may inform health promotion and policy strategies to prevent or reduce the effects of diabetes among Mexican Americans in the border region by increasing physical activity. This advance could hold the promise of reducing the risks and complications of chronic diseases that are more prevalent in this than in any other ethnic subgroup.