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
2Diabetes 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
3DM 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.
4Diabetes 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)
5Diabetes 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)
6Diabetes 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
7Risk 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
-
8What 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
9Meta-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)
10Aims
- 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
11Methods
- 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.
12Focus 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
-
13Participants
- 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)
14Focus 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
15Focus 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
16Findings 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 ..
17What 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 .
18What 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
19Causes 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
20Causes 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.
21Causes 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.
22Environmental 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.
23Environmental 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 .
24Physical 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
25Physical 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.
26Barriers 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
27Regular 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.
28Diabetes 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.
29Work 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.
30Other 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
31Diabetes 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
32Diet 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.
33Diet 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.
34Foods 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.
35Diabetes 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.
36Health 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.
37Community 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
38Health 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
39Conclusions
- Good understanding of the severity of diabetes
- The need to alter life stye
- More information
- More education
- Cultural and social barriers
- Interventions
- Doctors
- Groups
40Sulaiman ND, Furler JS, Hadj EJ, Corbett HM,
Young D. Health Promot J Austr. 2007
Apr18(1)63-8