Type 2 Diabetes (T2D) is a global epidemic that disproportionately affects socioeconomic and ethnic minority populations (International Diabetes Federation, 2013). Mapuches, the largest Native American population in Chile, shifted from the lowest incidence of T2D to equal rates in comparison to mainstream Chileans within a decade (King & Rewers, 1991; Perez-Bravo et al., 2001). This may be due to economic growth and rapid nutritional shifts (Yu & Zinman, 2007). Previous research has identified the importance of cultural beliefs in explaining health behavior (Betancourt, Flynn, & Ormseth, 2011). This study, guided by Betancourt’s Integrative Model for Culture, Psychological Factors and Behavior Adapted for the Study of Health Behavior (Betancourt & Flynn, 2009), examined the influence of cultural beliefs and self-efficacy on diet adherence. It was hypothesized that cultural beliefs about susceptibility to social pressure would be negatively associated with diet adherence directly and/or indirectly through diet self-efficacy. Multi-group structural equation modeling tested the impact of cultural beliefs and self-efficacy on diet adherence among Mapuches (n = 146) and mainstream Chileans (n = 244) with T2D. Both hypothesized models demonstrated an excellent fit to the data [Mapuches: CFI = .98, χ2 (12, n = 146) = 17.613, χ2/df = 1.47, SRMR = .06, RMSEA = .06, 90% CI (.00, .11); mainstream Chileans: CFI = 1.00, χ2 (12, n = 244) = 10.32, χ2/df = .86, SRMR = .03, RMSEA = .00, 90% CI (.00, .06)]. The indirect effect of cultural beliefs was significant for mainstream Chileans (βIndirect = -.084, p < .05) and had a similar effect for Mapuches (βIndirect = -.045, p = .12). A test of invariance was performed and demonstrated that the effect of any single variable on another variable did not differ due to ethnicity. This study highlighted the importance of examining indirect effects of cultural beliefs on health behaviors through psychological factors. Interventions would benefit from considering cultural beliefs about temptation and social norms surrounding food refusal as well as feelings of capability toward adherence. Future research should consider the role of other cultural and psychological factors on diet adherence, such as fatalism and social support.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Betancourt, Hector M.

Second Advisor

Flynn, Patricia M.

Third Advisor

Morrell, Holly E. R.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Diabetes Mellitus; Type 2 - diet therapy; Food Habits; Attitude to Health; Self Efficacy; Nutrition Surveys

Subject - Local

Type 2 Diabetes; Chile; Importance of Cultural Beliefs;



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives