Self-management, health service use and information seeking for diabetes care among Black Caribbean immigrants in Toronto

Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study

OBJECTIVES

Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities.

DESIGN AND SETTING

Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing.

PARTICIPANTS

Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes.

RESULTS

Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices.

CONCLUSIONS

Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.

Systematic review: Perceptions of type 2 diabetes of people of African descent living in high-income countries

AIMS

To describe how people of African descent perceive and understand type 2 diabetes, and to examine the impact of their perceptions and beliefs on the uptake of diet, exercise, weight control and adherence to medication recommendations.

DESIGN

Systematic literature review of quantitative and qualitative studies.

DATA SOURCES

We searched MEDLINE, CINAHL Complete, Psych INFO, Academic Search Premier, Education Research Complete, Web of Science and Scopus, World Health Organization (WHO), Diabetes UK and American Diabetes Association for articles published from January 1999 to December 2019.

REVIEW METHODS

Informed by the PRISMA guidelines, we independently reviewed titles and abstracts, identified articles for full-text review that met inclusion criteria, conducted a quality assessment and extracted data. Findings were synthesized using a thematic approach.

RESULTS

Twenty-six studies met the inclusion criteria. Knowledge and understanding of diabetes were poor. Beliefs and behaviours about diet, exercise, weight and health care were erroneous. Most diabetic participants could not recognize diabetes symptoms, failed to take their diagnosis seriously and did not adhere to medication recommendations. The resultant effect was an increased risk of complications with undesirable outcomes.

CONCLUSION

Poor diabetes perceptions are linked to negative consequences and may be responsible for poorer outcomes among people of African descent. This review highlights the need to consider this population's beliefs and practices in structuring culturally sensitive programmes for diabetes management.

IMPACT

This systematic literature review is the first to exclusively explore perceptions of people of African descent in relation to diabetes. It is important to consider people of African descents' diabetes perceptions and practices before formulating interventions for their diabetes management.

Adjusting the Canadian Healthcare System to Meet Newcomer Needs

Newcomers’ ability to access healthcare can be impacted by cultural, religious, linguistic, and health status differences. A variety of options are available to support the development of healthcare systems to equitably accommodate newcomers, including the use of basic English and other languages in public health information, engagement with immigrant communities to advise on program development, offering culturally competent health services, interpretation services, and through creating space to collaborate with traditional practitioners. This study employed in-depth interviews with newcomer families from the Healthy Immigrant Children Study that had been living in Regina or Saskatoon, Saskatchewan, Canada, for less than 5 years, as well as with healthcare providers and immigrant service providers to understand how to improve healthcare services. Analysis of participant quotes related to accessible healthcare services revealed five main themes: (1) responsive, accessible services, (2) increasing cultural competence, (3) targeted newcomer health services, (4) increasing awareness of health services, and (5) newcomer engagement in planning and partnerships. An accessible healthcare system should include primary healthcare sites developed in partnership with newcomer service organizations that offer comprehensive care in a conveniently accessible and culturally responsive manner, with embedded interpretation services. The Saskatchewan healthcare system needs to reflect on its capacity to meet newcomer healthcare needs and strategically respond to the healthcare needs of an increasingly diverse population.

Health Information Seeking Among Immigrant Families in Western Canada

PURPOSE

Studies on immigrant populations' access to healthcare in Canada tend to focus on adults and usually concentrate on specific ethnic groups, particularly South Asians and Chinese. This study sought to present the experiences of immigrant parents when they access health services for their children focusing specifically on the various sources of information that they used to improve their children's health.

DESIGN AND METHOD

This qualitative study was carried out in Edmonton, Alberta between April to October 2018. Fifty parents, chosen using purposive sampling participated in one-on-one semi-structured interviews. Interviews were recorded digitally, transcribed verbatim, and analyzed thematically.

RESULTS

We developed three main themes from the data: Accessing social networks for informational support, the role of professionals in accessing health care information, and navigating and evaluating information sources. The study demonstrates that immigrant families consulted various sources of information in order to meet their children's healthcare needs. The most common source was the Internet followed by friends and family members, and health care professionals.

DISCUSSION

Findings suggest that health information that is disseminated using the Internet needs to be made available in multiple languages to facilitate communication to persons who are not fluent in English nor French. Also, policy makers and health care professionals must increase focus on informal sources of health care information.

"A Touch of Sugar": A Qualitative Study of the Impact of Health Beliefs on Type 1 and Type 2 Diabetes Self-Management Among Black Canadian Adults

OBJECTIVES

Black Canadians have higher rates of diabetes and complications compared with White Canadians. However, research on diabetes self-management in this community is lacking. We conducted a qualitative study to explore diabetes self-management in the Black Canadian community using the lens of the Health Belief Model.

METHODS

Forty-three individuals who identify as Black Canadians, living with or caring for a person with diabetes, were recruited. Data were collected through focus groups and interviews, and then analyzed using content analysis.

RESULTS

We found that participants appreciated they are susceptible to diabetes based on family or peer experiences. Perceived severity is variable for which some believe that diabetes is only a "sugar problem," and the majority highlighted a perceived lack of knowledge about diabetes complications. Perceived benefits to treatment included prolonging life and cleansing one's body. Perceived barriers included lack of culturally appropriate dietary advice, lack of shared decision-making driven by a language barrier and cultural mismatch between patient and provider, socioeconomic status and difficulty navigating and accessing the Canadian health-care system. Peers, family members, churches and online platforms served as the main information sources and cues to action, influencing each of the 4 aforementioned categories. A number of solutions were proposed by the participants to address the barriers from patient, health-care delivery and health advocacy perspectives.

CONCLUSIONS

Black Canadians face unique barriers to diabetes self-management, some of which are rooted within health belief systems. Avenues for intervention include peer education through narratives and a renewed focus on providing culturally appropriate care.

Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden

INTRODUCTION

Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes.

METHODS AND ANALYSIS

An adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in self-management, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose.

ETHICS AND DISSEMINATION

The study has received approval in Uganda from the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and from the Uganda National Council for Science and Technology; in South Africa from the Biomedical Science Research Ethics Committee of the University of the Western Cape; and in Sweden from the Regional Ethical Board in Stockholm. Findings will be disseminated through peer-reviewed publications and scientific meetings.

TRIAL REGISTRATION NUMBER

ISRCTN11913581; Pre-results.

Delivering primary health care as envisioned: A model of health and well-being guiding community-governed primary care organizations

PURPOSE

For over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a "Model of Health and Well-being" (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada.

DESIGN/METHODOLOGY/APPROACH

The MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice.

FINDINGS

The MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes.

ORIGINALITY/VALUE

As comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

Diabetes-related information-seeking behaviour: a systematic review

BACKGROUND

Information-seeking behaviour is necessary to improve knowledge on diabetes therapy and complications. Combined with other self-management skills and autonomous handling of the disease, it is essential for achieving treatment targets. However, a systematic review addressing this topic is lacking. The aims of this systematic review were to identify and analyse existing knowledge of information-seeking behaviour: (1) types information-seeking behaviour, (2) information sources, (3) the content of searched information, and (4) associated variables that may affect information-seeking behaviour.

METHODS

The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. MEDLINE, CINAHL, EMBASE, ScienceDirect, PsycInfo, Cochrane Library, Web of Science, CCMed, ERIC, Journals@OVID, Deutsches Ärzteblatt and Karlsruher virtueller Katalog (KvK) databases were searched. Publications dealing with information-seeking behaviour of people with diabetes mellitus published up to June 2015 were included. A forward citation tracking was performed in September 2016 and June 2017. Additionally, an update of the two main databases (MEDLINE, CINAHL) was conducted, considering studies published up to July 2017. Studies published in languages other than English or German were excluded, as well as letters, short reports, editorials, comments and discussion papers. A study selection and the critical appraisal of the selected studies were performed independently by two reviewers. A third reviewer was consulted if any disagreement was found. Data extraction and content analysis were performed using selected dimensions of Wilson's 'model of information behaviour'.

RESULTS

Twenty-six studies were included. Five 'types of information-seeking behaviour' were identified, e.g. passive and active search. The 'Internet' and 'healthcare professionals' were the most frequently reported sources. 'Diet', 'complications', 'exercise' and 'medications and pharmacological interactions' were the most frequently identified content of information. Seven main categories including associated variables were identified, e.g. 'socioeconomic', 'duration of DM', and 'lifestyle'.

CONCLUSION

The systematic review provides a valuable overview of available knowledge on the information-seeking behaviour of people with diabetes mellitus, although there are only a few studies. There was a high heterogeneity regarding the research question, design, methods and participants. Although the Internet is often used to seek information, health professionals still play an important role in supporting their patients' information-seeking behaviour. Specific needs of people with diabetes must be taken into consideration.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016037312.

Iranian Women's Experiences of Health Information Seeking Barriers: A Qualitative Study in Kerman

BACKGROUND

Women as active health information seekers play a key role in determining lifestyle and possible implementation of preventive measures, thereby improving the health of individuals, families and society. Although studies indicate that equipping people with adequate health information leads to optimal health outcomes, sometimes the complexity of human behavior and presence of barriers and limitations expose them to challenges.

OBJECTIVES

This study was designed to explore women's experiences of health information seeking barriers.

PATIENTS AND METHODS

In this qualitative content analysis study, data collection was conducted regarding inclusion criteria, through purposive sampling and semi-structured interviews with 17 women and using documentation and field notes until data saturation. Qualitative data analysis was performed constantly and simultaneously with data collection.

RESULTS

Five central themes were emerged to explain women's experiences of barriers to health information seeking as inadequate support from health care system, shame and embarrassment, costs, wrong ideas and beliefs and inadequate health literacy.

CONCLUSIONS

It seems the accurate and evidence-based review of the current health system is crucial to support the health informative requirements in a community-based approach, respecting the community cultural-religious beliefs and client participation in health care and according to local resources.