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Althubyani AN, Gupta S, Tang CY, Batra M, Puvvada RK, Higgs P, Joisa M, Thomas J. Barriers and Enablers of Diabetes Self-Management Strategies Among Arabic-Speaking Immigrants Living with Type 2 Diabetes in High-Income Western countries- A Systematic Review. J Immigr Minor Health 2024; 26:761-774. [PMID: 38231345 PMCID: PMC11289197 DOI: 10.1007/s10903-023-01576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/18/2024]
Abstract
The aim of this review is to investigate barriers and enablers of diabetes self-management strategies among migrant Arabic-speaking background [ASB] individuals living with type 2 diabetes in high-income Western countries. Despite living in high-income Western countries, individuals from ASB are perceived to have difficulties adopting self-management strategies and this necessitates gaining an understanding of factors that may impact the uptake of these strategies. Ten studies are included in this review: five quantitative and five qualitative. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal and Hawker tools. The findings of the quantitative studies were descriptively analysed, while thematic analysis was performed for the qualitative studies. The results indicate that individuals from ASB are perceived to have low levels of adherence to diabetes self-management. It is also suggested that participants who did not complete high school have poorer glycaemic control compared to those with a high school qualification (30 vs. 16%). Regular exercise was reported to be less likely to be adopted by ASBs homemakers, and those who were unemployed, by 82% and 70%, respectively, compared to those employed (homemakers: OR = 0.187, P = 0.006; 95% CI = 056-0.620), (unemployed OR = 0.30, P = 0.046; 95% CI = 0.093-0.980). Cultural, social, religious beliefs, lack of knowledge and language barriers are some of the factors identified that impact self-management among ASB individuals. It is suggested that diabetes self-management education program (DSME) tailored to ASB immigrants culture may be an effective way to encourage them to uptake self-management strategies.
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Affiliation(s)
- Anwar Noor Althubyani
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia
- Department of Public Health, School of applied science, University of Tabuk, Tabuk, Saudi Arabia
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Clarice Y Tang
- Department of Physiotherapy, School of Health Sciences, Western Sydney University, Penrith, Australia
- Institute of Health and Sport, Victoria University, Melbourne, Australia
| | - Mehak Batra
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rahul Krishna Puvvada
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Markandeya Joisa
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia
| | - Jency Thomas
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia.
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Ajrouche S, Louis L, Esvan M, Chapron A, Garlantezec R, Allory E. HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019. BMC Endocr Disord 2024; 24:72. [PMID: 38769550 PMCID: PMC11103828 DOI: 10.1186/s12902-024-01601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Diabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme. METHOD The historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner's practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation. RESULTS HbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation. CONCLUSIONS These results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).
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Affiliation(s)
- Sarah Ajrouche
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Lisa Louis
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Maxime Esvan
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Anthony Chapron
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Ronan Garlantezec
- CHU de Rennes, Univ Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), Irset - UMR_S 1085, Rennes, 35000, France
| | - Emmanuel Allory
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France.
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France.
- LEPS (Laboratoire Educations et Promotion de la Santé), University of Sorbonne Paris Nord, UR 3412, Villetaneuse, F-93430, France.
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Hassan S, Rac VE, Hodges B, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HCK, Anderson M, Woods NN. Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review. BMJ Open 2024; 14:e081006. [PMID: 38262651 PMCID: PMC10806612 DOI: 10.1136/bmjopen-2023-081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented. DESIGN We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance. DATA SOURCES We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022. ELIGIBILITY CRITERIA We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs' training was described. DATA EXTRACTION AND SYNTHESIS The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency. RESULTS Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes. CONCLUSION This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations. PROSPERO REGISTRATION NUMBER CRD42022369208.
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Affiliation(s)
- Samah Hassan
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
| | - Valeria E Rac
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
| | - Brian Hodges
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Leake
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Saul Cobbing
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharine Marie Gray
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Nicola Bartley
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Andrea Etherington
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Munira Abdulwasi
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Hei-Ching Kristy Cheung
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Melanie Anderson
- University Health Network, Toronto, Ontario, Canada
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nicole N Woods
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
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Rohilla U, Ramarao JP, Lane J, Khatri NN, Smith J, Yin K, Lau AYS. How general practitioners and patients discuss type 2 diabetes mellitus and cardiovascular diseases concerns during consultations: Implications for digital health. Digit Health 2023; 9:20552076231176162. [PMID: 37426586 PMCID: PMC10328044 DOI: 10.1177/20552076231176162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/29/2023] [Indexed: 07/11/2023] Open
Abstract
Objective To analyse general practitioner-patient consultations about type 2 diabetes mellitus or cardiovascular diseases and describe (i) the nature of self-management discussions; (ii) actions required from patients during and after consultation regarding self-management; and (iii) implications for digital health to support patients during (and after) consultation. Method This study screened 281 general practitioner consultations conducted in 2017 within the UK general practice setting from an existing dataset containing videos and transcripts of consultations between GPs and patients. Secondary analysis was conducted using a multi-method approach, including descriptive, content, and visualisation analysis, to inform the nature of self-management discussions, what actions are required from patients, and whether digital technology was mentioned during the consultation to support self-management. Results Analysis of eligible 19 consultations revealed a discord between what self-management actions are required of patients during and after consultations. Lifestyle discussions are often discussed in depth, but these discussions rely heavily on subjective inquiry and recall. Some patients in these cohorts are overwhelmed by self-management, to the detriment of their personal health. Digital support for self-management was not a major topic of discussion, however, we identified a number of emergent gaps where digital technology can support self-management concerns. Conclusion There is potential for digital technology to reconcile what actions are required of patients during and after consultations. Furthermore, a number of emergent themes around self-management have implications for digitalisation.
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Affiliation(s)
- Urvashi Rohilla
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jayashanthi P Ramarao
- Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Jared Lane
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Neha N Khatri
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James Smith
- Centre for Precision Health, Collaborative Genomics and Translation Group, Edith Cowan University, Perth, WA, Australia
| | - Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Annie YS Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Lu S, Leduc N, Moullec G. Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3267-3278. [PMID: 36038395 DOI: 10.1016/j.pec.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations. METHODS A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021. RESULTS 76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice. CONCLUSIONS Various T2D peer support models lie at the interface between primary care and community-based settings. PRACTICE IMPLICATIONS Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
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Affiliation(s)
- Sonia Lu
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada.
| | - Nicole Leduc
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, Montreal, Canada
| | - Grégory Moullec
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada
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Alzubaidi H, Hafidh K, Saidawi W, Othman AM, Khakpour MM, Zoghbor MM, Abu-Gharbieh E, Alzoubi KH, Shaw JE. Behavioral, psychological, and clinical outcomes of Arabic-speaking people with type 2 diabetes during COVID-19 pandemic. Prim Care Diabetes 2022; 16:355-360. [PMID: 35410850 PMCID: PMC8993045 DOI: 10.1016/j.pcd.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/29/2022] [Indexed: 01/21/2023]
Abstract
AIMS Assess self-care activities, health behaviors, self-efficacy, diabetes distress, challenges, and changes in diabetes treatment and clinical parameters among Arabic-speaking people with T2DM during the COVID-19 pandemic. METHODS A cross-sectional study was conducted at a tertiary hospital in the United Arab Emirates. The study instrument collected self-reported data using validated tools about health behaviors, self-efficacy, and diabetes distress, and challenges in accessing and using healthcare services during the pandemic and documented clinical data and treatment before and during the pandemic from medical records. RESULTS 206 patients participated with a mean age of 58.7 years and 15.7 years since diabetes diagnosis. Non-adherence to healthful eating and exercise was reported by 38.3% and 73.7%, respectively. Exercise was the self-care activity that decreased the most (36.8%). Most participants had low diabetes distress (85.9%). There were no significant differences in clinical parameters before and during the pandemic, and diabetes treatment was unchanged for 72.8% of participants. Having two or more challenges with accessing and using diabetes healthcare services was significantly associated with decreased adherence to healthy eating (p = 0.025) and exercise (p = 0.003). CONCLUSIONS Arabic-speaking people with T2DM appeared to maintain relatively similar self-care levels, except exercise, with no deterioration in clinical parameters compared to pre-pandemic.
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Affiliation(s)
- Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates; Sharjah Institute for Medical Research, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Khadija Hafidh
- Rashid Hospital, Dubai Health Authority UAE, Dubai Medical College, United Arab Emirates.
| | - Ward Saidawi
- Sharjah Institute for Medical Research, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Amna M Othman
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Mahta M Khakpour
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Malaka M Zoghbor
- Pharmacist, Fakeeh University Hospital, Dubai Silicon Oasis, Dubai, United Arab Emirates.
| | - Eman Abu-Gharbieh
- Sharjah Institute for Medical Research, University of Sharjah, University City Road - University City, PO Box 27272, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | - Karem H Alzoubi
- College of Pharmacy, University of Sharjah, University City Road, University City, PO Box 27272, Sharjah, United Arab Emirates.
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Institute, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, PO Box 6492, Melbourne, VIC 3004, Australia.
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Goedhart NS, Pittens CACM, Tončinić S, Zuiderent-Jerak T, Dedding C, Broerse JEW. Engaging citizens living in vulnerable circumstances in research: a narrative review using a systematic search. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:59. [PMID: 34479622 PMCID: PMC8414765 DOI: 10.1186/s40900-021-00306-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Although public engagement in research is increasingly popular, the involvement of citizens living in vulnerable circumstances is rarely realized. This narrative review aims to describe and critically analyse concerns and corresponding strategies, tools, and methods that could support the inclusion of these citizens in health research. The 40 studies that are included were thematically analysed using the socioecological model. Concerns originate most often on the intrapersonal level of the socioecological model, but concerns were also identified at institutional, community, and policy levels. It is thought-provoking that there is a lack of attention for the research and policy structure in which engagement practices are designed, implemented and evaluated. More research is needed to explore how these cultures could be changed in a way that promotes rather than restrains the engagement of citizens living in vulnerable circumstances in research and policymaking.
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Affiliation(s)
- N S Goedhart
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands.
| | - C A C M Pittens
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Tončinić
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Dedding
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - J E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Roth P, Tang CY, Rumbold B, Gupta S. Knowledge and perceptions around self-management of type 2 diabetes among a Sudanese community in Australia: A qualitative study. Health Promot J Austr 2021; 33:869-879. [PMID: 34460974 DOI: 10.1002/hpja.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED People from Sudanese background are more likely to be diagnosed with type 2 diabetes (T2D) as compared to the general population. In recent years, there has been an increase in the number of migrants from Sudan to Australia. However, there is a dearth of research exploring the perceptions and experiences of self-management strategies for diabetes among this migrant Sudanese population residing in Australia. This study aims to explore these experiences and perceptions as well as to identify cultural aspects related to T2D self-management strategies for people from this migrant group. METHODS A qualitative study using semi-structured in-depth interviews with Sudanese participants (n = 12) living with T2D was conducted in Melbourne, Australia. RESULTS The thematic analysis found barriers to self-management of diabetes to include language differences, the burden of self-management, difficulties in accommodating traditional dietary practices in self-management, as well as the expectations of familial and social obligations. Enablers included positive relationships with health professionals, support networks, involvement in religion and adopting traditional remedies. CONCLUSIONS This study found cultural considerations, such as incorporating traditional dietary practices and familial obligations into self-management, to be the most significant influence for this group of Sudanese participants in the way they managed their diabetes. SO WHAT This study highlights the need for culturally appropriate provision of health services and resources for Sudanese people with T2D while recognising the value placed on traditional food choices. Importantly, the collectivist Sudanese culture must be considered for any future development and implementation of health promotion strategies.
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Affiliation(s)
- Phoebe Roth
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Level 1, 715 Swanston Street, Parkville, Victoria, Australia
| | - Clarice Y Tang
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Bruce Rumbold
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Outcomes of Culturally Tailored Dietary Intervention in the North African and Bangladeshi Diabetic Patients in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238932. [PMID: 33271775 PMCID: PMC7730264 DOI: 10.3390/ijerph17238932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023]
Abstract
Immigrants show higher adjusted diabetes prevalence than Italians, especially among South-East Asians followed by North and Sub-Saharan Africans. Diabetes progression is influenced by food behaviors, and diet control is a critical aspect in disease management. Food habits have many cultural and symbolic implications. Guidelines recommend that every patient should receive appropriate self-management education according to cultural and socioeconomic characteristics. This study aims to test whether a customized diet and transcultural mediator’s support can improve immigrants’ food habits. A pre-post quali-quantitative study was conducted among 20–79-year-old Bangladeshi and North African diabetic immigrants. The INMP transcultural mediator, an expert in the social and health care field, actively participates in clinical activity by decoding linguistic and cultural needs expressed by the foreigner patient. Five culturally tailored dietary profiles were designed according to international diabetes guidelines and adjusted to traditional food habits. Data were collected with two different semi-structured questionnaires. Changes in food consumption were assessed through McNemar’s test, while paired Wilcoxon Signed-Rank test was used to analyze pre and post intervention. Fifty-five patients were enrolled. At follow-up, cereals, meat, and potatoes intake significantly improved, and the number of adequate dietary habits for each patient increased significantly. Transcultural mediator support was 90% positively evaluated. Adherence to dietary control is favorably influenced by a transcultural intervention, which is based on clinical and socio-cultural criteria, in compliance with patient’s lifestyles.
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Barriers and facilitating factors in the prevention of diabetes type 2 and gestational diabetes in vulnerable groups: A scoping review. PLoS One 2020; 15:e0232250. [PMID: 32401778 PMCID: PMC7219729 DOI: 10.1371/journal.pone.0232250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 11/27/2022] Open
Abstract
Aims Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Methods We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized. Results We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge. Conclusion This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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Tatara N, Hammer HL, Mirkovic J, Kjøllesdal MKR, Andreassen HK. Associations Between Immigration-Related User Factors and eHealth Activities for Self-Care: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway. JMIR Public Health Surveill 2019; 5:e11998. [PMID: 31420957 PMCID: PMC6716338 DOI: 10.2196/11998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations' diverse electronic health (eHealth) activities for self-care, especially in European countries. OBJECTIVE With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status). METHODS Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem. RESULTS Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95% CI 2.487-13.053), and (3) variety (estimate=0.350, 95% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95% CI 1.265-3.480), and (3) variety (estimate=0.270, 95% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95% CI 1.335-6.227). CONCLUSIONS This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries. INTERNATIONAL REGISTERED REPORT RR2-DOI 10.2196/resprot.5468.
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Affiliation(s)
- Naoe Tatara
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Hugo Lewi Hammer
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Jelena Mirkovic
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway
| | - Marte Karoline Råberg Kjøllesdal
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Hege Kristin Andreassen
- Centre for Women's and Gender Research, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
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Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2019; 8:1-11. [PMID: 30788283 PMCID: PMC6366352 DOI: 10.2147/iprp.s133088] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death globally. This article explores the evidence surrounding community pharmacist interventions to reduce cardiovascular events and related mortality and to improve the management of CVD risk factors. We summarize a range of systematic reviews and leading randomized controlled trials and provide critical appraisal. Major observations are that very few trials directly measure clinical outcomes, potentially owing to a range of challenges in this regard. By contrast, there is an extensive, high-quality evidence to suggest that improvements can be achieved for key CVD risk factors such as hypertension, dyslipidemia, tobacco use, and elevated hemoglobin A1c. The heterogeneity of interventions tested and considerable variation of the context under which implementation occurred suggest that caution is warranted in the interpretation of meta-analyses. It is highly important to generate evidence for pharmacist interventions in developing countries where a majority of the global CVD burden will be experienced in the near future. A growing capacity for clinical registry trials and data linkage might allow future research to collect clinical outcomes data more often.
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Affiliation(s)
- Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, VIC, Australia,
- Deakin Health Economics, Centre for Population Health, Deakin University, Geelong, VIC, Australia,
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
| | - Hamzah Alzubaidi
- Institute for Medical Research and College of Pharmacy, University of Sharjah, Sharjah, Sharjah, United Arab Emirates
| | - John Keith Jackson
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
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Yin K, Harms T, Ho K, Rapport F, Vagholkar S, Laranjo L, Coiera E, Gershuny J, Lau AYS. Patient work from a context and time use perspective: a mixed-methods study protocol. BMJ Open 2018; 8:e022163. [PMID: 30580259 PMCID: PMC6307620 DOI: 10.1136/bmjopen-2018-022163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Self-management is widely promoted but less attention is focused on the work required from patients. To date, many individuals struggle to practise self-management. 'Patient work', a concept that examines the 'work' involved in self-management, is an approach to understanding the tasks, effort, time and context from patient perspective. The purpose of our study is to use a novel approach combining non-obstructive observations via digital devices with in-depth qualitative data about health behaviours and motivations, to capture the full range of patient work experienced by people with type 2 diabetes and chronic comorbidities. It aims to yield comprehensive insights about 'what works' in self-management, potentially extending to populations with other chronic health conditions. METHODS AND ANALYSIS This mixed-methods observational study involves a (1) prestudy interview and questionnaires, (2) a 24-hour period during which participants wear a camera and complete a time-use diary, and a (3) poststudy interview and study feedback. Adult participants living with type 2 diabetes with at least one chronic comorbidity will be recruited using purposive sampling to obtain a balanced gender ratio and of participants using insulin and those using only oral medication. Interviews will be analysed using thematic analysis. Data captured by digital devices, diaries and questionnaires will be used to analyse the duration, time, context and patterns of health-related behaviours. ETHICS AND DISSEMINATION The study was approved by the Macquarie University Human Research Ethics Committee for Medical Sciences (reference number 5201700718). Participants will carry a wallet-sized card that explains the purpose of the study to third parties, and can remove the camera at any stage. Before the poststudy interview begins, participants will view the camera images in private and can delete any images. Should any images be used in future publications or presentations, identifying features such as human faces and names will be obscured.
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Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Teresa Harms
- Department of Sociology, Centre for Time Use Research, University of Oxford, Oxford, UK
- Planning and Transport Research Centre, Business School, University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Ho
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sanjyot Vagholkar
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Gershuny
- Department of Sociology, Centre for Time Use Research, University of Oxford, Oxford, UK
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Salma J, Hunter KF, Ogilvie L, Keating N. An Intersectional Exploration: Experiences of Stroke Prevention in Middle-Aged and Older Arab Muslim Immigrant Women in Canada. Can J Nurs Res 2018. [PMID: 29536774 DOI: 10.1177/0844562118760076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Arab immigrants have increasing rates of stroke and uncontrolled stroke risk factors coupled with minimal resources for stroke prevention. Purpose This article describes the results of an interpretive descriptive study about Arab immigrant women's experiences of practicing stroke prevention. We use an intersectionality approach to discuss some of the factors that influenced women's ability to manage their health. Methods Sixteen middle-aged and older Arab Muslim immigrant women were recruited between 2015 and 2016 from two religious centers in an urban Canadian center. Women were between the ages of 45 and 75 years, were living in the community, and had a combination of stroke risk factors. Semi-structured interviews lasting 2-3 h were conducted in Arabic by the primary bilingual researcher. Data analysis was completed in Arabic, with final themes and exemplars translated to English with the support of a certified translator. Results Study themes include relating life stressors to physical health, pursuing knowledge in the dark, negotiating medication and treatment options, making an effort to eat healthy and be active, and identifying triple ingredients for empowerment. Conclusion Economic status, access to transportation, language fluency, life stressors, and personal coping strategies influenced Arab women's ability to manage personal health.
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Affiliation(s)
- Jordana Salma
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Linda Ogilvie
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Norah Keating
- 2 Department of Human Ecology, University of Alberta, Edmonton, AB, Canada
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Salma J, Keating N, Ogilvie L, Hunter KF. Social dimensions of health across the life course: Narratives of Arab immigrant women ageing in Canada. Nurs Inq 2017; 25:e12226. [PMID: 29230911 DOI: 10.1111/nin.12226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/26/2022]
Abstract
The increase in ethnically and linguistically diverse older adults in Canada necessitates attention to their experiences and needs for healthy ageing. Arab immigrant women often report challenges in maintaining health, but little is known about their ageing experiences. This interpretive descriptive study uses a transnational life course framework to understand Arab Muslim immigrant women's experiences of engaging in health-promoting practices as they age in Canada. Women's stories highlight social dimensions of health such social connectedness, social roles and social support that are constructed and maintained within different migration contexts across the life course. Barriers and facilitators to healthy ageing in this population centred around five themes: (i) the necessity of staying strong, (ii) caring for self while caring for others, (iii) double jeopardy of chronic illnesses and loneliness, (iv) inadequate support within large social networks and (v) navigating access to health-supporting resources. The findings point to transnational connections and post-migration social support as major influencers in creating facilitators and barriers to healthy ageing for Arab Muslim immigrant women.
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Affiliation(s)
- Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Norah Keating
- Faculty of Human Ecology, University of Alberta, Edmonton, AB, Canada
| | - Linda Ogilvie
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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