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Im H, George N, Swan LET. Gendered Health Outcome Among Somali Refugee Youth in Displacement: A Role of Social Support and Religious Belief. J Immigr Minor Health 2024; 26:341-350. [PMID: 37733168 DOI: 10.1007/s10903-023-01546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA.
| | - Nicole George
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, USA
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Hussein K, Shanley R, Schleiss MR. 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. DISCOVER SOCIAL SCIENCE AND HEALTH 2024; 4:16. [PMID: 38694881 PMCID: PMC11062319 DOI: 10.1007/s44155-024-00070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/29/2024] [Indexed: 05/04/2024]
Abstract
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.
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Affiliation(s)
- Khadra Hussein
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55454, USA
| | - Ryan Shanley
- Biostatistics Core, University of Minnesota Clinical and Translational Science Institute, 717 Delaware Street SE, Minneapolis, MN 55414, USA
| | - Mark R. Schleiss
- Division of Pediatric Infectious Diseases, University of Minnesota, 2001 6th Street SE, Minneapolis, MN 55455, USA
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Nekouei Marvi Langari M, Virtanen E, Lindström J, Turunen H. Registered nurses' perceptions of healthy lifestyle counselling for immigrants in primary healthcare: A focus group study. J Adv Nurs 2024. [PMID: 38258615 DOI: 10.1111/jan.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND The use of primary healthcare and health promotion services is low among immigrants compared with native citizens. Immigrants are at risk of developing chronic diseases due to genetics, nutrition and a sedentary lifestyle. Registered nurses play an integral role in teaching, counselling for a healthy lifestyle and care coordination in primary healthcare. AIM We aimed to explore the perceptions of registered nurses on healthy lifestyle counselling for preventing type 2 diabetes and other chronic diseases among immigrants in the primary healthcare setting. DESIGN We performed a qualitative descriptive study using focus group interviews. METHODS Data were collected with semi-structured focus group interviews with a total of 23 registered nurses working in primary healthcare. We recruited the participants by using the purposive sampling method in the primary healthcare setting of four municipalities in Finland. Interviews were audio-recorded, transcribed verbatim and analysed with qualitative inductive content analysis. RESULTS The participants' perceptions were related to (1) uniform counselling practice for both immigrants and native citizens, (2) challenges in counselling immigrants, (3) understanding cultural factors influencing immigrant counselling, (4) the need to improve immigrant counselling and (5) utilizing insights from practical experience to improve the counselling service. CONCLUSIONS Developing a culturally sensitive health promotion service is suggested to support the health of immigrants. Moreover, both migrant communities and healthcare professionals should be involved in co-designing and implementing health promotion projects through a community-based participatory approach. IMPACT Our study contributes to healthcare practice and management by underscoring the need for culturally tailored health promotion services for the at-risk group of immigrants in primary healthcare. Cultural competence in nursing education needs to be reinforced. The provided recommendations inform researchers and policymakers about the health disparities and health needs of immigrants. PUBLIC CONTRIBUTION Healthcare professionals were consulted in the study design.
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Affiliation(s)
| | - Eeva Virtanen
- Doctoral Programme of Population Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jaana Lindström
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
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Calogiuri G, Petersen E, Rossi A, Terragni L. The significance of green exercise for the health and wellbeing of Italian immigrants in Norway: a mixed-methods study. BMC Public Health 2023; 23:1514. [PMID: 37559019 PMCID: PMC10413808 DOI: 10.1186/s12889-023-16375-3] [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] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Green exercise (physical activity in presence of nature) has beneficial effects for health and wellbeing. Green exercise is a popular form of recreation in the Nordic countries, but participation is lower among the immigrant population from non-Western countries. However, no attention has been given to immigrants from the European Economic Area regarding this topic. Given the cultural and structural differences that surround green exercise in Italy and Norway, the case of the Italian immigrants in Norway is of interest to enrich our understanding of green exercise and its significance for health and wellbeing among immigrants in the Nordic countries. METHODS This convergent mixed methods study investigated the pathways that link green exercise to health and wellbeing among Italian immigrants in Norway. Quantitative data were collected through an online survey (n = 321), which was oversampled to better reflect the sociodemographic profile of the reference population. Logistic regression was used to model the association of green exercise with self-rated health (SRH) or satisfaction with life (SWL) before and after controlling for selected confounders (age, gender, educational level, language proficiency, social support, and childhood experiences with green exercise). Qualitative data were collected through semi-structured in-depth interviews (n = 14) and analysed thematically. Merging of the two strands was done using a simultaneous bidirectional approach. RESULTS The logistic regression found a significant bivariate association of green exercise with both SRH and SWL, though the association remained significant only for SWL after controlling for confounders. From the thematic analysis, three themes were identified: Green exercise opportunities contributing to overall satisfaction, Closeness to nature, and Embracing a new lifestyle. The integrated findings indicate that green exercise supported the immigrants' wellbeing, especially by providing stress relief, though socioeconomic status and acculturation may have a major impact on general health. Familiarity, appreciation of nature benefits, social support, and acculturation were identified as facilitating factors. CONCLUSIONS This study provides novel insights into how green exercise supports health, wellbeing, and inclusion among immigrants to the Nordic countries and emphasizes the importance of developing culturally adapted strategies to enhance this health-promoting activity among immigrant populations.
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Affiliation(s)
- Giovanna Calogiuri
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
- Department of Public Health and Sport Sciences, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
| | - Evi Petersen
- Department of Sports, Physical Education and Outdoor Life, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Bø i Telemark, Norway
- Department of Early Childhood Education, Faculty of Education and International Studies, Oslo Metropolitan University, Oslo, Norway
| | - Alessio Rossi
- Department of Computer Science, University of Pisa, Pisa, Italy
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Yoshino Y, Sato M, Abu-Siam I, Khost N, Honda S, Qarawi AT, Hassan OG, Huy NT, Kamiya Y. Assessment of physical activity and its facilitators and barriers among Syrian refugees living in Amman City, Jordan: a cross-sectional study. BMC Public Health 2022; 22:1732. [PMID: 36096788 PMCID: PMC9469621 DOI: 10.1186/s12889-022-14064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is one of the major risk factors for non-communicable diseases. Few studies about physical activity have been conducted among refugees from neighbouring countries. Given changes in the situation of Syrians, assessment of physical activity among Syrian refugees is required to understand their situation. This study aimed to evaluate the degree of self-reported physical activity and to identify perceived facilitators of and barriers to physical activity among Syrian refugees living in Amman, Jordan, in 2017. METHODS This community-based cross-sectional study was conducted using a structured questionnaire and the short form of the International Physical Activity Questionnaire. Participants were eligible for the study if they were Syrian refugees aged 18-64 years, living in Amman city, and were either registered with the United Nations High Commissioner for Refugees, waiting for their registration, or had a service card issued by the Jordanian Ministry of Interior. The relationship between physical activity level and sex was assessed using the chi-square test and Cochran-Armitage tests. The Mann-Whitney U test was performed to assess the relationship between the median metabolic equivalent scores of physical activity and gender. Backward stepwise logistic regression analysis was used to analyse the association between predictors of physical inactivity and physical activity level. RESULTS Among the 173 participants, the majority (91.9%) reported moderate to a high level of physical activity, and 8.1% were physically inactive. The metabolic equivalent scores for the walking activity of males (median: 1039.5, IQR: 0, 2772) was significantly higher than that of females (median: 396, IQR: 0, 1188) (p < 0.01). "Perceived change in the amount of physical activity" was a significant predictor of physical inactivity (adjusted OR = 3.00; 95%CI: 1.27-7.26). Common facilitators of physical activity were "psychological wellbeing"(49.7%) and "prevent diseases"(46.8%). The greatest barriers to physical activity were "time limitation"(43.4%) and "high cost"(57.8%). CONCLUSION This study revealed the physical activity level among Syrian refugees in Amman. The perceived facilitators and barriers to physical activity identified among Syrian refugees were similar to those in previous studies conducted among non-refugees. These results provide a valuable baseline for future examinations of physical activity level and to verify its possible facilitators and barriers.
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Affiliation(s)
- Yasue Yoshino
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Sumihisa Honda
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ahmad T Qarawi
- Fleetwood Speciality Pharmacy, New York, USA.,Online Research Club, Nagasaki, Japan
| | - Osama Gamal Hassan
- Online Research Club, Nagasaki, Japan.,Cardiology Department, El Zaitoun Specialized Hospital, Cairo, Egypt
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Online Research Club, Nagasaki, Japan
| | - Yasuhiko Kamiya
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
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Jenness SM, Aavitsland P, White RA, Winje BA. Measles vaccine coverage among children born to Somali immigrants in Norway. BMC Public Health 2021; 21:668. [PMID: 33827509 PMCID: PMC8028092 DOI: 10.1186/s12889-021-10694-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/23/2021] [Indexed: 01/31/2023] Open
Abstract
Background Despite overall good vaccination coverage in many countries, vaccine hesitancy has hindered full coverage and exposed groups to the risk of outbreaks. Somali immigrant groups have been known to have low measles vaccination coverage, leading to outbreaks in their communities. Current research indicates a general lack of trust in the healthcare system, the use of alternative information sources and inadequate health literacy can be contributing factors. We explore measles vaccine coverage in children born to Somali parents in Norway, whether it has changed over time and factors that may influence coverage. Methods Data was extracted from the National Population Register on all children born in Norway from 2000 to 2016, where both parents originated from Somalia. Date of birth, gender, residential area at birth and date of immigration and emigration for both parents was linked to information on measles vaccination from the National Immunisation Register. Results We found that children born to Somali immigrants in Norway had suboptimal measles vaccine coverage at 2 years; for children born in 2016 the coverage was 85%. Coverage declined between 2000 and 2016, and at a greater rate for boys than girls. Children born to mothers residing in Norway for 6 years or more had lower coverage compared to those with mothers residing less than 2 years prior to their birth. Children born in the capital and surrounding county had significantly lower coverage than children born elsewhere in Norway. Discussion New targeted interventions are needed to improve measles vaccine coverage among Somali immigrants in Norway. Some possible strategies include using Somali social media platforms, improving communication with Somali parents and tighter cooperation between various countries’ vaccination programmes.
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Affiliation(s)
| | - Preben Aavitsland
- Institute of Health and Medicine, University of Oslo, Oslo, Norway.,Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Richard Aubrey White
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Brita Askeland Winje
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
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Elshahat S, Newbold KB. Physical activity participation among Arab immigrants and refugees in Western societies: A scoping review. Prev Med Rep 2021; 22:101365. [PMID: 33868904 PMCID: PMC8042447 DOI: 10.1016/j.pmedr.2021.101365] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
Insufficient physical activity (PA) is the fourth prime risk factor for numerous non-communicable diseases. Arab immigrants and refugees (AIR) are at elevated risk for low or no participation in PA due to socio-cultural and ecological factors. This scoping review examined PA prevalence, knowledge, attitudes as well as barriers vs. facilitators to PA engagement across life domains among AIR in Western countries. A systematic search strategy was implemented across five automated databases (PubMed, Embase, Medline, Sociology Database and Transportation Research Board) to locate pertinent English language papers. Seventy-five articles were included in this study, and stakeholder consultation was conducted to validate the findings. The US and Europe are substantially ahead of Canada, Australia, and New Zealand in AIR-PA research. Despite showing positive attitudes and sound knowledge of PA recommendations, AIR exhibited a low PA engagement prevalence, revealing a knowledge-compliance gap. The prevalence of sufficient PA was lowest in the US (11-22%), whereas Europe showed the highest figures (26-45%). Personal barriers to PA participation involved mainstream language illiteracy and limited exercise skills, whereas improved PA literacy was a significant facilitator. Family responsibility and cultural restrictions were common psychosocial/cultural barriers, whereas social support and culturally-sensitive resources were powerful facilitators. Poorly maintained pedestrian/cyclist infrastructure was a leading environmental barrier amongst AIR in North America, but not Europe. Longitudinal and community-engaged AIR-PA research is needed, and intersectoral collaboration is required to inform tailored interventions and inclusive policies, fostering AIR and other vulnerable populations' exercise participation and improving their health and well-being.
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Affiliation(s)
- Sarah Elshahat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton L8S 4L9, Ontario, Canada
- Corresponding author.
| | - K. Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton L8S 4K1, Ontario, Canada
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Qureshi SA, Straiton M, Gele AA. Associations of socio-demographic factors with adiposity among immigrants in Norway: a secondary data analysis. BMC Public Health 2020; 20:772. [PMID: 32448125 PMCID: PMC7247236 DOI: 10.1186/s12889-020-08918-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is becoming an important public health challenge, especially among immigrants coming from low and middle income to high-income countries. In this study we examined the relationship between overweight/obesity and various socio-demographic indicators among different immigrant groups in Norway. METHODS We used data from the Living Conditions Survey among Immigrants 2016, conducted by Statistics Norway. Our study sample included 4194 immigrants from 12 different countries. Participants were asked about a number of topics including health, weight, height, demographic factors, length of residence and employment. We ran logistic regression analysis to determine the odds ratio (OR) of the associations between socio-demographic factors with adiposity among immigrants. RESULTS Approximately 53% of the sample was overweight/obese. There was a significant difference in overweight/obesity by gender, age, country of origin and marital status. Overall immigrant men were almost 52% more likely to be overweight/obese than women. Women from Somalia had the highest odds (13.1; CI: 7.4-23.1) of being overweight/obese, followed by Iraq (8.6; CI: 4.9-14.9), Pakistan (7.5; CI: 4.2-13.4), Kosovo (7.0; CI: 4.1-12.1), and Turkey (6.8; CI: 4.0-11.6) as compared to the women from Vietnam (reference). Whereas men from Turkey had the highest odds (5.2; CI: (3.2-8.3)) of being overweight/obese, followed by Poland (4.2; CI: 2.7-6.1), Bosnia (4.1; CI: (2.6-6.5) and Kosovo (3.9; CI: 2.5-6.1). The odds for obesity increased with age and odds were highest in the eldest group 45-66 years (4.3; CI: 3.2-5.8) as compared to reference group16-24 years. The odds of being overweight/obese was higher among married (1.6; CI: 1.3-1.9) and divorced/separated/widowed (1.5; CI: 1.1-2.0) as compared to singles. Education, employment status, physical activity and length of residence were not associated with the odds of being overweight/obese. CONCLUSION The findings of this study call attention to the importance of a greater understanding of the processes leading to obesity among certain immigrant groups in Norway. Moreover, there is a need for culturally adapted prevention strategies targeting immigrant men and women with high rates of overweight/obesity.
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Affiliation(s)
- Samera Azeem Qureshi
- Unit for Migration & Health, Norwegian Institute of Public Health (NIPH), P.O.Box 222, 0213, Oslo, Skøyen, Norway.
| | - Melanie Straiton
- Department of Mental Health and Suicide, Norwegian Institute of Public Health (NIPH), P.O.Box 222, 0213, Oslo, Skøyen, Norway
| | - Abdi A Gele
- Unit for Migration & Health, Norwegian Institute of Public Health (NIPH), P.O.Box 222, 0213, Oslo, Skøyen, Norway
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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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Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Access to Norwegian healthcare system - challenges for sub-Saharan African immigrants. Int J Equity Health 2019; 18:125. [PMID: 31412853 PMCID: PMC6693278 DOI: 10.1186/s12939-019-1027-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immigrants face barriers in accessing healthcare services in high-income countries. Inequalities in health and access to healthcare services among immigrants have been previously investigated. However, little is known on the sub-Saharan African immigrants' (SSA) access to the Norwegian healthcare system. METHODS The study had a qualitative research design. We used the snowball technique to recruit participants from networks including faith-based organizations and cultural groups. Forty-seven qualitative in-depth interview and two focus group discussions with immigrants from sub-Saharan African were conducted from October 2017 to July 2018 in Oslo and its environs. Interviews were conducted in Norwegian, English or French, audio-recorded and transcribed verbatim into English. The analysis was based on a thematic approach, using NVivo software. Interview data were analyzed searching for themes and sub-themes that emerged inductively from the interviews. RESULTS Our findings reveal barriers in two main categories when accessing the Norwegian healthcare services. The first category includes difficulties before accessing the healthcare system (information access, preference for doctors with an immigrant background, financial barriers, long waiting time and family and job responsibility). The second category includes difficulties experienced within the system (comprehension/expression and language, the black elephant in the room and dissatisfaction with healthcare providers). CONCLUSION Healthcare is not equally accessible to all Norwegian residents. This ultimately leads to avoidance of the healthcare system by those most in need. Lack of seeking healthcare services by immigrants from Sub Saharan Africa may have significant implications for the long-term health of this group of immigrants. Therefore measures to address the issues raised should be prioritized and further examined.
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Affiliation(s)
- Vivian N Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Abdi A Gele
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette N Kumar
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
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Zhu T, Xu H. Status and influencing factors of diabetes information acquisition among rural elderly with pre-diabetes in Yiyang City, China: a cross-sectional study. BMJ Open 2019; 9:e029938. [PMID: 31324685 PMCID: PMC6661561 DOI: 10.1136/bmjopen-2019-029938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This study was designed to investigate the status of diabetes information acquisition and its influencing factors among patients, 60 years and older, with pre-diabetes in rural China. DESIGN This is a cross-sectional study. SETTING The survey was conducted in 42 rural communities in Yiyang City, Hunan Province, China. PARTICIPANTS A total of 461 elderly with pre-diabetes participated in this study, and 434 of them completed the survey (434/461, 94.1%). OUTCOME MEASURES Information on sociodemographic and diabetic information-seeking behaviours were assessed through the structured questionnaires and described by percentages, mean±SD. The influencing factors of diabetes information acquisition were analysed using multiple linear regression analysis. RESULTS The average score of diabetes information acquisition in the subjects was 8.39±11.28. The most popular and trusted source of diabetes information for the subjects was doctors. The level of information acquisition not only declined as the age progressed (95% CI -3.754 to -0.143) but also proved lowest among subjects with less than 1 year of education (95% CI 0.756 to 4.326). In addition, the level of information acquisition among elderly individuals with pre-diabetes, but with no history of hyperglycaemia, was lower than among those with a history of hyperglycaemia (95% CI 3.398 to 11.945). CONCLUSIONS These data indicated that the lack of ability to acquire diabetes information in elderly with pre-diabetes was common in rural China. Improving the ability of rural residents to access information should be incorporated into rural diabetes prevention efforts, especially for the elderly with pre-diabetes with low education and no history of hyperglycaemia. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15007033; Pre-results.
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Affiliation(s)
- Tingting Zhu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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Mishra SR, Ghimire S, Joshi C, Gyawali B, Shrestha A, Neupane D, Sharma SR, Pokharel Y, Virani SS. Cardio-metabolic disease risk factors among South Asian labour migrants to the Middle East: a scoping review and policy analysis. Global Health 2019; 15:33. [PMID: 31046779 PMCID: PMC6498694 DOI: 10.1186/s12992-019-0468-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/13/2019] [Indexed: 01/11/2023] Open
Abstract
This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) risk factors among South Asian labor migrants to the Middle East. We conducted a qualitative synthesis of literature using PubMed/Medline and grey literature searches, supplemented by a policy review of policies from the South Asian countries. We found a high burden of cardio-metabolic risk factors among the migrants as well as among the populations in the home and the host countries. For example, two studies reported the prevalence of diabetes mellitus (DM) ranging between 9 and 17% among South Asian migrants. Overweight and obesity were highly prevalent amongst South Asian male migrants; prevalence ranged from 30 to 66% (overweight) and 17-80% (obesity) respectively. The home country population had a significant CMD risk factor burden. Nearly 14 to 40% have three or more risk factors: such as hypertension (17 to 37%), diabetes (3 to 7%), overweight (18 to 41%), and obesity (2 to 15%). The host country also exhibited similar burden of risk factors: hypertension (13 to 38%), diabetes (8 to 17%), overweight (33 to 77%) and obesity (35 to 41%). Only Nepal, Bangladesh and Sri Lanka have some provisions related to screening of CMDs before labor migration. Further, analysis of policy papers showed that none of the reviewed documents had requirements for screening of any specific CMDs, but chronic diseases were used generically, failing to specify specific screening target. Given the high burden of risk factors, migrants' health should become an urgent priority. The lack of specific focus on screening during different stages of labor migration should receive attention. The International Labour Organization and the International Office for Migration, through their country coordination teams should engage local stakeholders to create policies and plans to address this concern. Similarly, there is a need for the host country to become an equal partner in these efforts, as migrant's better cardiometabolic health is in the benefit of both host and home countries.
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Affiliation(s)
| | | | | | - Bishal Gyawali
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Archana Shrestha
- Harvard T Chan School of Public Health, Harvard University, Boston, MA USA
| | - Dinesh Neupane
- Nepal Development Society, Bharatpur-10, Chitwan, Nepal
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sudesh Raj Sharma
- Institute of Food, Nutrition and Human Health, Massey University, Wellington, New Zealand
| | - Yashashwi Pokharel
- Saint Luke’s Mild America Heart Institute, University of Missouri Kansas City, Kansas City, MO USA
- Health Foundation Nepal, Lalitpur, Nepal
- America Nepal Medical Foundation, Westfield, MA USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX USA
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
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13
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Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening. J Immigr Minor Health 2019; 22:87-95. [DOI: 10.1007/s10903-019-00881-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Zulfiqar T, Nolan CJ, Banwell C, Young R, Boisseau L, Ingle M, Lithander FE. Barriers to a healthy lifestyle for three- to four-year-old children of Australian-born and overseas-born mothers with post-gestational diabetes: An Australian qualitative study. J Child Health Care 2018; 22:447-459. [PMID: 29444583 DOI: 10.1177/1367493518759240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children of mothers affected by gestational diabetes mellitus (GDM) are at higher risk of long-term cardio-metabolic diseases. We explore the diet and physical activity knowledge and practices of Australian-born and overseas-born mothers with GDM history, for their three- to four-year-old children following antenatal health promotion education at a tertiary hospital. We conducted face-to-face, semi-structured interviews with 8 Australian-born and 15 overseas-born mothers with a history of GDM. Findings indicated that mothers of both groups were unaware of the increased health risks of their GDM for their children and could not recall receiving specific dietary or physical activity advice aimed at future child health. Their understanding of the diet and physical activity recommendations was inconsistent. Mothers of both groups expressed concern about the lack of reiteration of child health promotion messages following childbirth, particularly at postnatal follow-up visits. Diet and physical activity of the children of overseas-born mothers were adversely affected by inadequate maternal understanding of the recommendations due to language barriers, and child weight, healthy eating, and physical activity patterns derived from their home countries. We recommend enhanced health education for women with GDM on the future child health risks and their reduction by healthy lifestyle choices. This needs to be culturally relevant and reiterated after pregnancy.
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Affiliation(s)
- Tehzeeb Zulfiqar
- 1 National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christopher J Nolan
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia.,3 ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Cathy Banwell
- 1 National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Rosemary Young
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia
| | - Lynelle Boisseau
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia
| | - Martha Ingle
- 2 ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, Australia
| | - Fiona E Lithander
- 4 NIHR Bristol Biomedical Research Centre (Nutrition Theme), at University Hospitals, Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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15
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Barry E, Greenhalgh T, Fahy N. How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review. BMC Med 2018; 16:121. [PMID: 30049283 PMCID: PMC6062879 DOI: 10.1186/s12916-018-1107-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several countries, including England, have recently introduced lifestyle-focused diabetes prevention programmes. These aim to reduce the risk of individuals with pre-diabetes developing type 2 diabetes. We sought to summarise research on how socio-cultural influences and risk perception affect people's behaviour (such as engagement in lifestyle interventions) after being told that they have pre-diabetes. METHODS Using the RAMESES standards for meta-narrative systematic reviews, we identified studies from database searches and citation-tracking. Studies were grouped according to underlying theorisations of pre-diabetes. Following a descriptive analysis, the studies were synthesised with reference to Cockerham's health lifestyle theory. RESULTS In total, 961 titles were scanned, 110 abstracts assessed and 35 full papers reviewed. Of 15 studies included in the final analysis, 11 were based on individual interviews, focus groups or ethnography and five on structured questionnaires or surveys. Three meta-narratives emerged. The first, which we called biomedical, characterised pre-diabetes as the first stage in a recognised pathophysiological illness trajectory and sought to intervene with lifestyle changes to prevent its progression. The second, which we called psychological, focused on the theory-informed study of the knowledge, attitudes and behaviours in people with pre-diabetes. These studies found that participants generally had an accurate perception of their risk of developing diabetes, but this knowledge did not directly lead to behavioural change. Some psychological studies incorporated wider social factors in their theoretical models and sought to address these through action at the individual level. The third meta-narrative we termed social realist. These studies conceptualised pre-diabetes as the product of social determinants of health and they applied sociological theories to explore the interplay between individual agency and societal influences, such as the socio-cultural context and material and economic circumstances. They recommended measures to address these structural influences on lifestyle choices. CONCLUSIONS The study of pre-diabetes to date has involved at least three research disciplines (biomedicine, psychology and sociology), which up to now have operated largely independently of one another. Behavioural science and sociology are increasing our understanding of how personal, social, cultural and economic aspects influence health-related behaviours. An interdisciplinary approach with theoretically informed multi-level studies could potentially improve the success of diabetes prevention strategies. TRIAL REGISTRATION Prospero Registration Number: CRD42018088609 .
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Affiliation(s)
- Eleanor Barry
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG, UK.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG, UK
| | - Nicholas Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG, UK
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16
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Hjörleifsson S, Hammer E, Díaz E. General practitioners' strategies in consultations with immigrants in Norway-practice-based shared reflections among participants in focus groups. Fam Pract 2018; 35:216-221. [PMID: 29029132 DOI: 10.1093/fampra/cmx097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immigrants comprise 16.8% of the population in Norway and meet General Practitioners (GPs) as their first point of contact with most health care services as do others in Norway. While Norwegian GPs are not trained in cultural competence, little is known about the extent to which they see good care for immigrants as relying on specific strategies. OBJECTIVES To explore the thoughts of GPs in Norway about strategies they might use with immigrant patients. METHODS We performed focus groups posing the question 'What strategies do you use when meeting immigrant patients?' to three groups of GPs working in Norway. Two groups comprised 10 trainee GPs each; the final group comprised eight certified GPs. Verbatim transcripts were analysed by systematic text condensation. RESULTS Strategies for consultations with immigrants emerged gradually throughout the focus groups, coalescing around (i) Respect and learn about immigrant culture. (ii) Particularize diagnosis and care, accommodating epidemiological and cultural knowledge for a given group, while keeping a keen eye on the individual. (iii) Inform about Norwegian health care. (iv) Organize resources such as time, translators and interdisciplinary teams. Other core elements of cultural competence, including reflections on the GP's own cultural background, were conspicuously absent, however. CONCLUSION Given the growing numbers of immigrants and the early transfer of refugees to general practice, our study points to the urgent need of supplementing teaching in patient-centred clinical method with cultural competence. Our study also highlights the potential of educational GP groups to develop strategies for cross-cultural consultations.
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Affiliation(s)
- Stefán Hjörleifsson
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Esperanza Díaz
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
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17
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Diaz E, Mbanya VN, Gele AA, Kumar B. Differences in primary health care use among sub-Saharan African immigrants in Norway: a register-based study. BMC Health Serv Res 2017; 17:509. [PMID: 28754117 PMCID: PMC5534034 DOI: 10.1186/s12913-017-2404-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Background Immigrants’ utilization of primary health care (PHC) services differs from that of the host populations. However, immigrants are often classified in broad groups by continent of origin, and the heterogeneity within the same continent may hide variation in use among immigrant groups at a national level. Differences in utilization of PHC between sub-Saharan African immigrants have not received much attention. Methods Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration. African immigrants and their descendants registered in Norway in 2008 (36,366 persons) where included in this study. Using χ2 test and logistic regression models, we assessed the differences in the use of PHC, including general practitioner (GP) and emergency room (ER) services, and the distribution of morbidity burden for immigrants from Somalia, Ethiopia, Eritrea, and Gambia. For the analyses, we used the number of visits and medical diagnoses from each consultation registered by the physician. Result Among the total studied population, 66.1% visited PHC within 1 year. The diagnoses registered were similar for all four immigrants groups, regardless of country of origin. Compared to immigrants from Somalia, the age and sex adjusted odds ratios (OR) for use of GP were significantly lower for Ethiopians (OR 0.91; 0.86–0.97), Eritreans (OR 0.85; 0.79–0.91), and Gambians (OR 0.88; 0.80–0.97). Similarly, we also observed lower use of ER among Ethiopians (OR 0.88; 0.81–0.95), Eritreans (OR 0.56; 0.51–0.62) and Gambians (OR 0.81; 0.71–0.92). However, immigrants from Somalia reduced their use of PHC with longer duration of stay in Norway. Differences between groups persisted after further adjustment for employment status. Conclusion Despite the similarities in diagnoses among the sub-Saharan African immigrant groups in Norway, their use of PHC services differs by country of origin and length of stay. It is important to assess the reasons for the differences in these groups to identify barriers and facilitators to access to healthcare for future interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2404-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Vivian N Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O Box 1130, Blindern, 0318, Oslo, Norway.
| | - Abdi A Gele
- Norwegian Centre for Minority Health Research, Oslo, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Bernadette Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway.,Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O Box 1130, Blindern, 0318, Oslo, Norway
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Gele AA, Pettersen KS, Torheim LE, Kumar B. Health literacy: the missing link in improving the health of Somali immigrant women in Oslo. BMC Public Health 2016; 16:1134. [PMID: 27809815 PMCID: PMC5093985 DOI: 10.1186/s12889-016-3790-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/20/2016] [Indexed: 01/27/2023] Open
Abstract
Background Existing studies report a positive association between inadequate health literacy and immigrant’s adverse health outcomes. Despite substantial research on this topic among immigrants, little is known about the level of health literacy among Somali women in Europe, and particularly in Norway. Methods A cross sectional study using respondent driven sampling was conducted in Oslo, Norway. A sample of 302 Somali women, 25 years and older, was interviewed using the short version of the European Health Literacy Questionnaire. Data was analysed using logistic regression. Results Findings revealed that 71 % of Somali women in Oslo lack the ability to obtain, understand and act upon health information and services, and to make appropriate health decisions. Being unemployed (OR 3.66, CI 1.08–12.3) and socially less integrated (OR 8.17, CI 1.21–54.8) were independent predictors of an inadequate health literacy among Somali women. Conclusions Enhanced health literacy will most likely increase the chance to better health outcomes for immigrants, thereby moving towards health equity in the Norwegian society. Therefore, policies and programs are required to focus and improve health literacy of immigrant communities.
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Affiliation(s)
- Abdi A Gele
- The Institute of Nursing and Health promotion, Oslo and Akershus University College, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway. .,Norwegian Center For Minority Health Research, Oslo University Hospital, Oslo, Norway.
| | - Kjell Sverre Pettersen
- The Institute of Nursing and Health promotion, Oslo and Akershus University College, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Liv Elin Torheim
- The Institute of Nursing and Health promotion, Oslo and Akershus University College, P.O. Box 4, St. Olavs plass, 0130, Oslo, Norway
| | - Bernadette Kumar
- Norwegian Center For Minority Health Research, Oslo University Hospital, Oslo, Norway
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Gele AA, Pettersen KS, Kumar B, Torheim LE. Diabetes Risk by Length of Residence among Somali Women in Oslo Area. J Diabetes Res 2016; 2016:5423405. [PMID: 27314048 PMCID: PMC4897676 DOI: 10.1155/2016/5423405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/08/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Type 2 diabetes represents a major health problem worldwide, with immigrants strongly contributing to the increase in diabetes in many countries. Norway is not immune to the process, and immigrants in the country are experiencing an increase in the prevalence of diabetes after arrival. However, the dynamics of these transitions in relation to the duration of residence in the new environment in Norway are not clearly understood. From this background, a cross-sectional quantitative study using a respondent-driven sampling method was conducted among 302 Somali women living in Oslo area. The results show that 41% of the study participants will be at risk for developing diabetes in the coming 10 years, which coincides with 85% of the study participants being abdominally obese. Significant associations were found between years of stay in Norway and the risk for diabetes with those who lived in Norway >10 years, having twofold higher odds of being at risk for developing diabetes compared to those who lived in Norway ≤5 years (OR: 2.16, CI: 1.08-4.32). Understanding the mechanisms through which exposure to the Norwegian environment leads to higher obesity and diabetes risk may aid in prevention efforts for the rapidly growing African immigrant population.
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Affiliation(s)
- Abdi A. Gele
- Oslo and Akershus University College of Applied Sciences, P.O. Box 4, Street Olavs Plass, 0130 Oslo, Norway
- Norwegian Center for Minority Health Research, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Kjell Sverre Pettersen
- Oslo and Akershus University College of Applied Sciences, P.O. Box 4, Street Olavs Plass, 0130 Oslo, Norway
| | - Bernadette Kumar
- Norwegian Center for Minority Health Research, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Liv Elin Torheim
- Oslo and Akershus University College of Applied Sciences, P.O. Box 4, Street Olavs Plass, 0130 Oslo, Norway
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