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How Turkish and Arabic Speaking Communities TASC View Diabetes and Pre diabetes

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Title: How Turkish and Arabic Speaking Communities TASC View Diabetes and Pre diabetes


1
  • How Turkish and Arabic Speaking Communities
    (TASC) View Diabetes and Pre diabetes?
  • A qualitative Study
  • Nabil Sulaiman, Doris Young, John Furler, Elaine
    Hadj, Helen Corbett

Medical Research Grants Restricted Purposes funds
2
Diabetes Australia Facts 2008
  • Type 2 Diabetes (T2DM) in CALD populations
  • Prevalence of diabetes
  • Prevalence of risk factors
  • Complications
  • Hospitalisations due to non-treatable diabetes
  • Death rates due to diabetes

3
DM in M.E born Vs. Australian born
  • highest SRR for self-reported DM
  • twice the rate (79.8 vs 46.2/1000) of DM
  • highest hospitalisations rate, and
  • 2nd highest MRR from DM
  • AIHW Cat. No. AUS 38. Canberra, 2003.

4
Diabetes CVD in Hume
  • DALYs for diabetes in Hume is the highest in
    Victoria (6.8 vs. 4.1 per 1,000 female) (6.6 vs.
    4.5 per 100,000 males)
  • DALYs for cardiovascular disease is the second
    highest in Victoria (31.9 vs. 27.6 per 1,000
    females) (35.4 vs. 32.2 per 1,000 males)

5
Diabetes in Arabs Turks
  • M.E. born highest age-standardised
  • Prevalence ratio in M (3.60) and F (2.43)
  • Incidence rate ratios M(1.73) F(2.30)
  • Hospitalisations ratios M(2.07) F(1.52)
  • Death rates higher in Arabic speaking residents
    in NSW (25.4 vs 13.4 per 100,000)

6
Diabetes in Arabs Turks
  • 40 Arab American have dysglycemia
  • 18 diagnosed or undiagnosed diabetes
  • 23 impaired fasting glucose or impaired glucose
    tolerance
  • 12.3 in Turks living in Holland vs 3 in ethnic
    Dutch
  • 35 in Bahrain, 13 in Turkey

7
Risk Factors Hume Household Survey (PHP 1999)
  • 76 were physically inactive compared with 43
    average for Victoria
  • 62 had weight problems
  • 39 had high cholesterol
  • 49 smoked

8
What could be done?
  • 57 reduction of T2D by modifying physical
    activity and dietary change (Lindstrom et al,
    2003 and Knowles et al, 2003)
  • Uptake of such lifestyle changes in lower SES
    CALD groups has been poor
  • 50 of people born in M.E. countries did not
    undertake physical exercise compared with 34 of
    Australian-born

9
Meta-analysis of 11 trials in CALD
  • Improved HbA1c after intervention at 3M
  • Weight Mean Difference -0.3 at 3M and 0.6 at 6M
  • Knowledge scores improved at 3M
  • Healthy life style improvement at 3M
  • No difference in secondary outcomes lipid
    levels, qoL, self-efficacy, BP
  • Hawthorne K, Robles Y, Cannings-John
    R, Edwards S. Culturally appropriate health
    education for type 2 diabetes in ethnic minority
    groups. Cochrane Database of Systematic Revies
    2008 (3)

10
Aims
  • Explore insight, perception, attitudes and
    practices of TASC, in relation to physical
    activity (PA), diet and obesity
  • The feasibility of peer led model of engaging the
    community in diabetes prevention

11
Methods
  • Focus Groups
  • In depth interviews with key informants
    (bilingual GPs, diabetes educators, practice
    nurses, dieticians, physios etc.
  • Develop culturally sensitive resources for TASC
    in Turkish and Arabic languages.


12
Focus Groups - recruitment
  • Who?
  • Over the age of 45 years
  • Speaks Arabic or Turkish language
  • Family history of diabetes
  • Overweight
  • Dont do exercise regularly
  • How?
  • BHS bilingual staff
  • Adult Day Activity Centre
  • Community Centre- Blair Street
  • Families and Friends


13
Participants
  • Three FG with Turkish speaking
  • Two FG with Arabic speaking
  • Mean age 58.8 (range 41y 73 y)
  • FM 41 11
  • All living in and around Hume
  • Interpreters from TIS
  • Facilitators Elaine Hadj and NS
  • Transcribed by Sue Foley
  • Analysis and cross analysis (NS Helen)

14
Focus Group Themes
  • What does the word diabetes mean to you?
  • ? causes diabetes
  • ? factors associated with diabetes
  • ? factors increase risk of diabetes
  • ? diabetes and diet?
  • ? diabetes and overweight/ obesity
  • ? role of exercise in diabetes


15
Focus Group Themes
  • Is adult diabetes preventable? How can you
    prevent diabetes?
  • ? type of exercise is appropriate for your
    community/ yourself? How often do you/your
    community exercise
  • ? motivate you/ your community to do exercise
  • ? types of diet do you/your family/ community
    prefer?
  • ? diabetes and body weight


16
Findings what diabetes meant to you?
  • Acknowledgement of the severity its a bad
    disease which is second to cancer,
  • Physical and psychological well beingAll of my
    ancestors, they have Diabetes, this why I said it
    is horrible disease, and some of them they had
    amputations of their limbs. Three of them their
    hands or their legs they were amputated, but one
    of them refused to do such a thing ..

17
What diabetes meant to you?
  • Specific
  • It means stress or It means a lot of food
    that you cant eat.
  • When the pancreas is not working so well it is
    not producing Insulin for the body to maintain
    the sugar levels and the amount of sugar in the
    blood goes quite high .

18
What do you associate with Diabetes?
  • It affects the eyes
  • swelling and ulceration of the legs (The legs
    get swollen and sometimes blood will come out and
    it doesnt heal).
  • Cuts dont heal
  • Increased thirst and urination
  • Poor dietary habits or eating the wrong food,
    limitations on food choices
  • Stress (Stress is one of the main things that
    causes illnesses)
  • Lack of exercise, Cholesterol, High blood
    pressure

19
Causes of diabetes
  • Lifestyle Poor diet and eating habits
  • We eat so much, I dont know, maybe because we
    eat so many times a day like 10 oclock, 11 we
    eat. We eat . and then we watch TV, we eat
    chips, so a sign of we eat all of the time.
  • I think its because we eat too much food, not
    the way we prepare, but we eat too much.
  • Stress and tension
  • Diet and stress. I am worried that it will come
  • Anxiety is another reason behind many diseases,
    the anxiety, tension and stress
  • its destiny
  • its hereditary

20
Causes Anxiety, tension stress
  • That also stress causes Diabetes as well if
    someone is overly stressed for long lengthy
    periods.
  • The Diabetes well the sugar level in my body if
    I was sad or happy it either picks up and goes
    quite high or drops down to very low levels with
    sadness or happiness.
  • And I was adding to that stress that illnesses
    including Diabetes is caused by stress. Stress
    is one of the main things that causes illnesses.

21
Causes Food
  • fast food as the culprit.
  • You get very sick when you have bad food. Fast
    food anyway. Its terrible for your body and you
    getting sick.
  • I think I shouldnt eat any Takeaway food. None
    whatsoever. I ate McDonalds once and fell ill for
    a couple of days so home cooking. What I mean
    is, they are too fatty.
  • Í think meat and rice in my opinion is not
    right, but again meat and bread also another
    issue.

22
Environmental factors
  • climate change I dont know that my sugar levels
    going to Turkey for instance is quite maintained
    when I am over there and when I come back here it
    creeps up again.
  •  I should say that it is not only going overseas
    but going to high places up in the hills or the
    forest or something, living there for a while I
    often maintain my sugar levels.
  •  I dont know again but it is because of the
    clarity of the air maybe and the oxygen level is
    quite high.

23
Environmental factors - cont
  • All the .. the skin, the meat, they all contain
    additives and we eat every cold chicken for
    example I believe that my condition had
    developed because of that.
  • For example you go to Turkey and you get an egg,
    a village egg, it will be natural and the eggs
    here they dont have any vitamins.
  • (In Australia) it is the way they grow their
    food, everything has a chemical additive, if they
    want to grow bigger eggs, bigger fruit, there is
    chemicals .

24
Physical activity
  • Walking is good
  • Its the cheapest exercise, it is healthy and it
    is outdoors
  • Exercise brings your blood sugars down
  • Helps with weight control
  • Improves blood circulation
  • Maintains sugar levels
  • Helps in weight reduction
  • Improved state of mind

25
Physical activity
  • it is incidental walking yes that you dont have
    the benefit of a car, you are only there for a
    short period but you have to walk a lot and at
    some places you have got no choice but to walk,
    you know 10 kilometres a day or 15.
  • When I went to Syria I lost 8 Kilos I walked a
    lot and didnt do any exercise bike, and I ate a
    lot. . Here you get into the car and you just
    drive in the car.
  • the session I have had with a Diabetes Nurse and
    she told me that My sugar levels were quite
    high up to 16 and 20 and when I have started
    walking which was recently I now walk every day
    and 1 ½ hours each day so my sugar levels have
    come down dramatically to about 7.

26
Barriers to regular exercise
  • Not feeling safe from dogs and other people
    (Walking in the street is not safe.)
  • Housework to complete
  • Family commitments like babysitting, housework
    etc.
  • Women dont make time for themselves
  • Laziness
  • Historically, exercise is not a part of Turkish
    life
  • Not culturally appropriate for older women to
    walk in the streets or go swimming (..60, 70
    year old woman going under and going swimming or
    walking, it is not looked upon as nice.)
  • Too old or too ill
  • Not enough time

27
Regular exercise facilitators
  • When directed to do so by their doctor
  • Group walks and group exercises
  • Ethnic dancing
  • Teacher or leader for walking and exercise groups
  • Exercise equipment or machine at home
  • Attending the gym and cycling
  • Illness and illness prevention
  • Weight control
  • A desire to get out of the house, a means of
    socialising
  • for relaxation (gardening)
  • As a community, unless you are ill and you have
    to exercise so you wont die, then that is the
    motivation.

28
Diabetes prevention
  • .there are many factors for me, the diet,
    exercises and tensions, stress.
  • Well, you can prevent by watching what you eat,
    doing exercise, walking, less stress, no stress,
    keep away from stress.
  • You cant prevent it from happening, but you can
    or the amount of Diabetes you get can be
    controlled. The severity of it.

29
Work and Diabetes
  • As a person I only found that I had Diabetes
    when I left work after about six months of
    leaving work.
  • I used to be working in the past and as I have
    given up work I have sustained Diabetes, I think
    it may have been because of inactivity that I
    have sustained Diabetes and not enough exercise
    anymore.

30
Other Causes
  • Obesity The amount of fat in your body that is
    as you get fatter you would have less chance of
    being active and inactivity causes and your
    pancreas would slow down.
  • Old age
  • Ethnicity

31
Diabetes and diet.
  • Foods that were detrimental to their health and
    to the health of people with diabetes
  • Fast foods
  • Fatty/oily food
  • Sweets
  • Breads
  • Rice
  • Pasta
  • Many fruits
  • Fatty meats

32
Diet and Diabetes
  • Eating anything and everything
  • Sweets, bread. All sugary things are bad Certain
    fruits for instance grapes, oranges.
  • Eating has something to do with it of course,
    you can eat anything but you have to eat it in
    moderation. It is the amount of food that is
    quite important.
  • I just gave up bananas and I found out that if
    you eat quite mature bananas that could have
    effects on your level of Diabetes but if you have
    not so mature like almost green bananas that is
    probably okay and having not 2 oranges but maybe
    ½ an orange or ½ an apple would be okay.

33
Diet and Diabetes
  • we used to eat anything that was culturally
    appropriate we eat a lot of nuts and things so
    handfuls of it usually and she (diabetes
    educator) told us that you can eat these nuts
    still but only that fits in the palm of your
    hand.
  • Because it is sour I tend to eat green apples
    and grape fruit tend to bring down the levels of
    sugar. Just like grape fruit and lemon I
    think it has the affect of dropping down the
    sugar level because of the sourness. The green
    apple has the same effect and the red apple lifts
    up the levels of Diabetes.

34
Foods that counter sweetness
  • Because it is sour, I tend to (eat) green apples
    and grape fruit tend to bring down the levels of
    sugar.
  • I have read in the paper that eating Grape
    Fruit can cause death.. I dont know how but I
    read it in a health section of the paper, I used
    to like grape fruit but as Diabetics dont take
    it anymore. I used to eat two grape fruits a day
    thinking it was a fruit of life, you know a fruit
    that would maintain your life, lengthen your life
    and I had a tree in the backyard when I learnt
    about the affects of it I chopped it down.

35
Diabetes and obesity
  • Lots of weight, being overweight and it is
    heredity as well, you cant help it sometimes.
  • the main cause of Diabetes is being overweight
    and if someone is overweight they almost surely
    will have Diabetes.
  • What is happening is if you eat and eat and keep
    the nutrition in your body without burning, its
    not like a petrol tank. If you went and filled up
    with petrol you cant put more when it is full,
    but the body is able to take more and more and it
    stores more, it increases your risk.

36
Health Education
  • The doctor and the hospital
  • In some instances nurses, dieticians and other
    educators
  • Negative experiences with Doctors and Hospitals
    I have been seeing the doctors and the Diabetes
    specialists for many years and they could not
    help me and I have just seen an educator here and
    she has helped me.
  • Need for InterpretersI went for an appointment
    (to have my eyes checked) and an interpreter
    wasnt booked and with that I couldnt understand
    what the doctor was saying and they have given me
    another appointment in a years time and now I
    dont know what the hell is going on.

37
Community Empowerment
  • Limited response
  • Volunteering for peer support is limited
  • Wiling to participate in peer-led diabetes
    prevention
  • Partnerships with
  • Local Council
  • Community Health Centres
  • Exercise centres

38
Health Education Resources
  • Written information to be shown to other family
    members or friends
  • Information is best provided when translated to
    languages other than English
  • Suggestions
  • Doctors
  • The hospital, Health Centres
  • Ethno-specific newspapers, Brochures and flyers
  • Community radio
  • Meetings similar to the focus group to share
    information and provide support to one another

39
Conclusions
  • Good understanding of the severity of diabetes
  • The need to alter life stye
  • More information
  • More education
  • Cultural and social barriers
  • Interventions
  • Doctors
  • Groups

40
Sulaiman ND, Furler JS, Hadj EJ, Corbett HM,
Young D. Health Promot J Austr. 2007
Apr18(1)63-8
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