Strengths and limitations
T2D, diabetes
DIABETES
This study possesses several strengths. It expands on the long-term implementation challenges of a peer-leader support program alongside culturally sensitive diabetes education for T2D self-management in resource-constrained environments. Notably, it identifies the sources of these challenges and provides an in-depth discussion of the potential solutions for overcoming them. Furthermore, this work underscores the importance of adopting regionally tailored approaches to specific community needs, thus contributing to more effective and contextually relevant healthcare solutions. Additionally, participants received comprehensive, evidence-based self-management training that was culturally adapted to their language and sociocultural context. By doing so, this approach has the potential to perpetuate knowledge and self-management practices within the communities beyond the intervention completion. Finally, the use of original data collected from Mexican Mayan communities living in underresourced, at-risk conditions uncovers health inequities within these under-explored populations. This exposure promotes awareness and advocacy for more equitable distribution of information, knowledge, and resources as part of broader development efforts.Limitations of this work include the presence of non-random missing data and significant attrition rates that prevented formal statistical analyses to determine the intervention’s effectiveness on T2D-related indicators. Nonetheless, this study’s primary objective was to discuss the lessons learned from implementing similar peer-leader support programs in two distinct Mayan communities, elaborate on the challenges encountered, and offer directions for future research employing similar strategies in underserved populations. Therefore, statistical analyses are included solely to illustrate these challenges in support of the discussion.We employed nationally validated tools for data collection but acknowledged that cultural differences in Mayan communities (e.g., language differences) could influence accuracy. In an effort to address this constraint, we engaged local personnel and bilingual community leaders to ensure accurate data collection while bridging cultural gaps. While our primary focus was not to provide a validation framework for these tools, we tested the reliability of the selected tools via Cronbach’s alpha and Sphericity Analyses and results demonstrated internal consistency. Even though the subgroup of bilingual participants (individuals proficient in both Mayan and Spanish) showed a slightly lower Cronbach estimate for both questionnaires (<0.02), we anticipate that the potential bias introduced by the selected tools will not influence the lessons learned derived from our findings.Differences in implementation between Conkal and Komchen interventions may limit direct community comparisons. For example, the ratio from peer-leaders to participants in Conkal was 0.14, whereas in Komchen, this ratio was 0.31. These disparities, however, emphasize the need to share our learned lessons, including the careful consideration of methods for identifying ideal PLs in diverse communities. 