Understanding Cultural Beliefs in Families of Somali Children with Diabetes in the Twin Cities, Minnesota

Exploring health disparities in congenital CMV (cCMV): a study in a Somali-American community to assess awareness of cCMV and facilitate understanding of universal cCMV screening

Background

Congenital cytomegalovirus (cCMV) disproportionately impacts black and multiracial infants. While there have been strides made to address this health disparity, strategies to increase awareness and knowledge of cCMV have not been investigated in a Somali community.

Methods

Two survey study strategies (in-person and online), consisting of a pre-survey test, educational intervention, and a post-survey, were designed to gauge knowledge and perceptions about cCMV among Somali women aged 18 to 40 years old.

Results

96 respondents partook in the online module, and 15 in the in-person event. On recruitment, < 45% of women were aware of cCMV. Following the pre-intervention survey, educational modules were conducted, and the survey repeated. For statistical comparisons, a point was assigned for each correct survey query, and the mean of correct responses tabulated for pre- and post-surveys. In the online intervention, mean scores changed from 55 to 87% (paired t-test, p = 0.001), whereas in the in-person intervention, mean scores changed from 65 to 87% (paired t-test, p = 0.007), demonstrating enhanced cCMV awareness upon completion of both interventions. Using multiple linear regression, the expected post-test score was 2% (95% CI [- 8%, 12%]) higher for the online module compared to the in-person module, adjusting for pre-test score.

Conclusion

Both interventions were successful in enhancing knowledge about cCMV in this population, although there was no evidence either intervention was substantially better than the other. Educational efforts will be critical in enhancing the trust required to facilitate diagnostic evaluation and treatment of newborns identified with cCMV in this high-risk population.

A picture is worth a thousand words: A culturally-tailored video-based approach to diabetes education in Somali families of children with type 1 diabetes

Objectives

Type 1 diabetes (T1D) is highly prevalent in Somali immigrant children and hemoglobin A1c (HbA1c) levels are elevated in this population compared to non-Hispanic Whites. Current self-management diabetes education has not been tailored to this population. We aimed to improve delivery of T1D education to Somali immigrants by developing and testing a culturally-appropriate video-based curriculum.

Methods

This cross-sectional study involved Somali youth ≤ 19 years with T1D followed at two pediatric tertiary centers in Minnesota. Ten Somali-language T1D education videos were developed (∼60 min for total program) based on core ADA curriculum and tailored to address cultural concerns and misconceptions. A diabetes knowledge questionnaire was administered to parents of all participants and to children aged ≥12 years. Pre- and post-educational session questionnaire mean scores were compared using a paired t-test to assess knowledge improvement immediately post-video education (primary endpoint) and retention at 3 months (secondary endpoint). HbA1c was measured pre- and 6 months post education (exploratory endpoint).

Results

Twenty-two Somali parents of 22 children participated (mean age 12.3 ± 4 years; 36 % female), 12 children ≥12 years. Diabetes knowledge scores significantly improved immediately post-video education compared to baseline (p = 0.012). This improvement persisted 3 months later (p = 0.0008). There was no significant change in mean HbA1c from baseline at 6 months post education (9.0 ± 1.5 % vs 9.3 ± 1.9; p = 0.6).

Conclusion

Culturally and linguistically tailoring diabetes education materials to African immigrants and delivering it audio-visually could improve effectiveness of diabetes education and increase knowledge and retention compared to simply translating standard diabetes education materials. The effect on HbA1c needs further study with a larger sample size.

What do parents believe are the causes of their Type 1 diabetic child's condition?

Purpose

This paper aims to investigate parents' beliefs about the causes of their child's Type 1 diabetes to understand if this affects the way diagnosis is processed and if this impacts on sibling parenting.

Design/methodology/approach

Online, semi-structured qualitative interviews with nine parents of children with Type 1 diabetes who have at least one non-diabetic child. The results were analysed using interpretative phenomenological analysis (IPA).

Findings

Two interlinked themes were identified: “What ifs”: parents postulated underlying genetic reasons for their child's diabetes and had working theories about the triggers of diabetes that included stress, infection, vaccination or a virus. Developing a personal aetiology of their child's condition allowed some a feeling of control, while others focused on practical ways to manage diabetes. “Having something to blame”: narratives dwelt on the relationship between beliefs about causes and self-blame. Some believed that acting on an identified trigger reduced personal guilt.

Research limitations/implications

Although internet access is widespread in the UK, a limitation of this research is that it excluded those without internet access.

Practical implications

The findings of this research may provide greater depth and a more holistic perspective to the health promoter to better support parents of Type 1 diabetics.

Social implications

The analysis of illness narratives that this research provides may offer a greater understanding of the social context in which health and illness develop. This research found some examples of parental confidence about the causes and triggers of their child's diabetes being positively associated with a sense of control. This might indicate the value of a more comprehensive larger-scale study to establish whether parents who are supported to develop a personalised conception of the aetiology of their child's diabetes develop a greater sense of coherence and well-being regarding their child's condition.

Originality/value

There is very limited literature focusing on the beliefs of sufferers and their families about Type 1 diabetes causality. Of that which does exist, some research is heterogenous in its sampling of Types 1 and 2 diabetes sufferers. This study offers a rare, focused insight into the beliefs of parents about the background causes and more proximal triggers of their child's Type 1 diabetes.

A picture-based carbohydrate-counting resource for Somalis

Objective

Carbohydrate counting is essential for effective management of type 1 diabetes (T1D). Somali diet-specific carbohydrate-counting references are lacking, creating an additional barrier to effective diabetes control. We developed a picture-based carbohydrate-counting resource for Somalis with T1D.

Methods

Traditional Somali foods were selected using a variety of methods. Serving sizes and carbohydrate calculations were tabulated using the United States Department of Agriculture National Nutrient Database for Standard Reference. Carbohydrate contents of home-prepared foods were calculated by measuring the total yield and total carbohydrates of ingredients in the recipe divided by the number of servings to be consumed. When available, recipes were used for food preparation and analysis for more accurate carbohydrate estimation.

Results

Photographs of prepared Somali foods were compiled into a PDF file. While introductions are written in text, the resource is primarily picture-based to bypass limited literacy. The resource is shared free of charge via the following link: http://journals.sagepub.com/doi/suppl/10.1177/0300060517718732 . The link will be updated annually with new information.

Conclusion

There is a necessity to tailor educational materials to address the needs of Somalis with diabetes. We have created a picture-based nutrition resource for carbohydrate counting of traditional Somali foods and have made this freely available to individuals worldwide.