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Diabetes Australia Facts 2008. Type 2 Diabetes (T2DM) in CALD populations: Prevalence of diabetes Prevalence of risk factorsComplicationsHospitalisations due to non-treatable diabetesDeath rates due to diabetes. . DM in M.E born Vs. Australian born. highest SRR for self-reported DM ~ twice
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1. How Turkish and Arabic Speaking Communities (TASC) View Diabetes and Pre diabetes?
A qualitative Study
Nabil Sulaiman, Doris Young, John Furler, Elaine Hadj, Helen Corbett
2. Diabetes Australia Facts 2008 Type 2 Diabetes (T2DM) in CALD populations:
Prevalence of diabetes
Prevalence of risk factors
Complications
Hospitalisations due to non-treatable diabetes
Death rates due to diabetes
3. DM in M.E born Vs. Australian born highest SRR for self-reported DM
~ twice the rate (79.8 vs 46.2/1000) of DM
highest hospitalisations rate, and
2nd highest MRR from DM
AIHW Cat. No. AUS 38. Canberra, 2003.
4. Diabetes & CVD in Hume DALYs for diabetes in Hume is the highest in Victoria (6.8 vs. 4.1 per 1,000 female) (6.6 vs. 4.5 per 100,000 males)
DALYs for cardiovascular disease is the second highest in Victoria (31.9 vs. 27.6 per 1,000 females) (35.4 vs. 32.2 per 1,000 males)
5. Diabetes in Arabs & Turks M.E. born highest age-standardised:
Prevalence ratio in M (3.60) and F (2.43)
Incidence rate ratios M(1.73) F(2.30)
Hospitalisations ratios M(2.07) F(1.52)
Death rates higher in Arabic speaking residents in NSW (25.4 vs 13.4 per 100,000)
6. Diabetes in Arabs & Turks >40% Arab American have dysglycemia:
18% diagnosed or undiagnosed diabetes
23% impaired fasting glucose or impaired glucose tolerance
12.3% in Turks living in Holland vs 3% in ethnic Dutch
35% in Bahrain, 13% in Turkey
7. Risk Factors: Hume Household Survey (PHP 1999) 76% were physically inactive compared with 43% average for Victoria
62% had weight problems
39% had high cholesterol
49% smoked
8. What could be done? 57% reduction of T2D by modifying physical activity and dietary change (Lindstrom et al, 2003 and Knowles et al, 2003)
Uptake of such lifestyle changes in lower SES & CALD groups has been poor
>50% of people born in M.E. countries did not undertake physical exercise compared with 34% of Australian-born
9. Meta-analysis of 11 trials in CALD Improved HbA1c after intervention at 3M
Weight Mean Difference -0.3% at 3M and 0.6% at 6M
Knowledge scores improved at 3M
Healthy life style improvement at 3M
No difference in secondary outcomes: lipid levels, qoL, self-efficacy, BP
Hawthorne K, Robles Y, Cannings-John R, Edwards S. Culturally appropriate health education for type 2 diabetes in ethnic minority groups. Cochrane Database of Systematic Revies 2008 (3)
10. Aims Explore insight, perception, attitudes and practices of TASC, in relation to physical activity (PA), diet and obesity
The feasibility of peer led model of engaging the community in diabetes prevention
11. Methods Focus Groups
In depth interviews with key informants (bilingual GPs, diabetes educators, practice nurses, dieticians, physios etc.
Develop culturally sensitive resources for TASC in Turkish and Arabic languages.
12. Focus Groups - recruitment Who?
Over the age of 45 years
Speaks Arabic or Turkish language
Family history of diabetes
Overweight
Dont do exercise regularly
How?
BHS bilingual staff
Adult Day Activity Centre
Community Centre- Blair Street
Families and Friends
13. Participants Three FG with Turkish speaking
Two FG with Arabic speaking
Mean age= 58.8 (range 41y 73 y)
F:M = 41 : 11
All living in and around Hume
Interpreters from TIS
Facilitators: Elaine Hadj and NS
Transcribed by Sue Foley
Analysis and cross analysis (NS& Helen)
14. Focus Group Themes What does the word diabetes mean to you?
? causes diabetes
? factors associated with diabetes
? factors increase risk of diabetes
? diabetes and diet?
? diabetes and overweight/ obesity
? role of exercise in diabetes
15. Focus Group Themes Is adult diabetes preventable? How can you prevent diabetes?
? type of exercise is appropriate for your community/ yourself? How often do you/your community exercise
? motivate you/ your community to do exercise
? types of diet do you/your family/ community prefer?
? diabetes and body weight
16. Findings: what diabetes meant to you? Acknowledgement of the severity: its a bad disease which is second to cancer,
Physical and psychological well being:All of my ancestors, they have Diabetes, this why I said it is horrible disease, and some of them they had amputations of their limbs. Three of them their hands or their legs they were amputated, but one of them refused to do such a thing ..
17. What diabetes meant to you? Specific:
It means stress or It means a lot of food that you cant eat.
When the pancreas is not working so well it is not producing Insulin for the body to maintain the sugar levels and the amount of sugar in the blood goes quite high .
18. What do you associate with Diabetes? It affects the eyes
swelling and ulceration of the legs (The legs get swollen and sometimes blood will come out and it doesnt heal).
Cuts dont heal
Increased thirst and urination
Poor dietary habits or eating the wrong food, limitations on food choices
Stress (Stress is one of the main things that causes illnesses)
Lack of exercise, Cholesterol, High blood pressure
19. Causes of diabetes Lifestyle: Poor diet and eating habits
We eat so much, I dont know, maybe because we eat so many times a day like 10 oclock, 11 we eat. We eat . and then we watch TV, we eat chips, so a sign of we eat all of the time.
I think its because we eat too much food, not the way we prepare, but we eat too much.
Stress and tension
Diet and stress. I am worried that it will come
Anxiety is another reason behind many diseases, the anxiety, tension and stress
its destiny
its hereditary
20. Causes: Anxiety, tension & stress That also stress causes Diabetes as well if someone is overly stressed for long lengthy periods.
The Diabetes well the sugar level in my body if I was sad or happy it either picks up and goes quite high or drops down to very low levels with sadness or happiness.
And I was adding to that stress that illnesses including Diabetes is caused by stress. Stress is one of the main things that causes illnesses.
21. Causes: Food fast food as the culprit.
You get very sick when you have bad food. Fast food anyway. Its terrible for your body and you getting sick.
I think I shouldnt eat any Takeaway food. None whatsoever. I ate McDonalds once and fell ill for a couple of days; so home cooking. What I mean is, they are too fatty.
think meat and rice in my opinion is not right, but again meat and bread also another issue.
22. Environmental factors climate change I dont know that my sugar levels going to Turkey for instance is quite maintained when I am over there and when I come back here it creeps up again.
I should say that it is not only going overseas but going to high places up in the hills or the forest or something, living there for a while I often maintain my sugar levels.
I dont know again but it is because of the clarity of the air maybe and the oxygen level is quite high.
23. Environmental factors - cont All the .. the skin, the meat, they all contain additives and we eat every cold chicken for example; I believe that my condition had developed because of that.
For example you go to Turkey and you get an egg, a village egg, it will be natural and the eggs here they dont have any vitamins.
(In Australia) it is the way they grow their food, everything has a chemical additive, if they want to grow bigger eggs, bigger fruit, there is chemicals .
24. Physical activity Walking is good
Its the cheapest exercise, it is healthy and it is outdoors
Exercise brings your blood sugars down
Helps with weight control
Improves blood circulation
Maintains sugar levels
Helps in weight reduction
Improved state of mind
25. Physical activity it is incidental walking yes that you dont have the benefit of a car, you are only there for a short period but you have to walk a lot and at some places you have got no choice but to walk, you know 10 kilometres a day or 15.
When I went to Syria I lost 8 Kilos I walked a lot and didnt do any exercise bike, and I ate a lot. . Here you get into the car and you just drive in the car.
the session I have had with a Diabetes Nurse and she told me that My sugar levels were quite high up to 16 and 20 and when I have started walking which was recently I now walk every day and 1 hours each day so my sugar levels have come down dramatically to about 7.
26. Barriers to regular exercise Not feeling safe from dogs and other people (Walking in the street is not safe.)
Housework to complete
Family commitments like babysitting, housework etc.
Women dont make time for themselves
Laziness
Historically, exercise is not a part of Turkish life
Not culturally appropriate for older women to walk in the streets or go swimming (..60, 70 year old woman going under and going swimming or walking, it is not looked upon as nice.)
Too old or too ill
Not enough time
27. Regular exercise & facilitators When directed to do so by their doctor
Group walks and group exercises
Ethnic dancing
Teacher or leader for walking and exercise groups
Exercise equipment or machine at home
Attending the gym and cycling
Illness and illness prevention
Weight control
A desire to get out of the house, a means of socialising
for relaxation (gardening)
As a community, unless you are ill and you have to exercise so you wont die, then that is the motivation.
28. Diabetes prevention .there are many factors for me, the diet, exercises and tensions, stress.
Well, you can prevent by watching what you eat, doing exercise, walking, less stress, no stress, keep away from stress.
You cant prevent it from happening, but you can or the amount of Diabetes you get can be controlled. The severity of it.
29. Work and Diabetes As a person I only found that I had Diabetes when I left work after about six months of leaving work.
I used to be working in the past and as I have given up work I have sustained Diabetes, I think it may have been because of inactivity that I have sustained Diabetes and not enough exercise anymore.
30. Other Causes Obesity: The amount of fat in your body that is as you get fatter you would have less chance of being active and inactivity causes and your pancreas would slow down.
Old age
Ethnicity
31. Diabetes and diet. Foods that were detrimental to their health and to the health of people with diabetes:
Fast foods
Fatty/oily food
Sweets
Breads
Rice
Pasta
Many fruits
Fatty meats
32. Diet and Diabetes Eating anything and everything
Sweets, bread. All sugary things are bad Certain fruits for instance grapes, oranges.
Eating has something to do with it of course, you can eat anything but you have to eat it in moderation. It is the amount of food that is quite important.
I just gave up bananas and I found out that if you eat quite mature bananas that could have effects on your level of Diabetes but if you have not so mature like almost green bananas that is probably okay and having not 2 oranges but maybe an orange or an apple would be okay.
33. Diet and Diabetes we used to eat anything that was culturally appropriate we eat a lot of nuts and things so handfuls of it usually and she (diabetes educator) told us that you can eat these nuts still but only that fits in the palm of your hand.
Because it is sour I tend to eat green apples and grape fruit tend to bring down the levels of sugar. Just like grape fruit and lemon I think it has the affect of dropping down the sugar level because of the sourness. The green apple has the same effect and the red apple lifts up the levels of Diabetes.
34. Foods that counter sweetness Because it is sour, I tend to (eat) green apples and grape fruit tend to bring down the levels of sugar.
I have read in the paper that eating Grape Fruit can cause death.. I dont know how but I read it in a health section of the paper, I used to like grape fruit but as Diabetics dont take it anymore. I used to eat two grape fruits a day thinking it was a fruit of life, you know a fruit that would maintain your life, lengthen your life and I had a tree in the backyard when I learnt about the affects of it I chopped it down.
35. Diabetes and obesity Lots of weight, being overweight and it is heredity as well, you cant help it sometimes.
the main cause of Diabetes is being overweight and if someone is overweight they almost surely will have Diabetes.
What is happening is if you eat and eat and keep the nutrition in your body without burning, its not like a petrol tank. If you went and filled up with petrol you cant put more when it is full, but the body is able to take more and more and it stores more, it increases your risk.
36. Health Education The doctor and the hospital
In some instances nurses, dieticians and other educators
Negative experiences with Doctors and Hospitals I have been seeing the doctors and the Diabetes specialists for many years and they could not help me and I have just seen an educator here and she has helped me.
Need for InterpretersI went for an appointment (to have my eyes checked) and an interpreter wasnt booked and with that I couldnt understand what the doctor was saying and they have given me another appointment in a years time and now I dont know what the hell is going on.
37. Community Empowerment Limited response
Volunteering for peer support is limited
Wiling to participate in peer-led diabetes prevention
Partnerships with:
Local Council
Community Health Centres
Exercise centres
38. Health Education Resources Written information to be shown to other family members or friends
Information is best provided when translated to languages other than English
Suggestions:
Doctors
The hospital, Health Centres
Ethno-specific newspapers, Brochures and flyers
Community radio
Meetings similar to the focus group to share information and provide support to one another
39. Conclusions Good understanding of the severity of diabetes
The need to alter life stye
More information
More education
Cultural and social barriers
Interventions:
Doctors
Groups