Challenges of managing diabetes in Asians

Journal of Diabetes Nursing,  Feb, 2004  by Kirpal Marwa,  Shanaz Mughal,  Harbinder Sunsoa,  Roytun Bibi

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Introduction

This article highlights the challenges faced by Asian people with diabetes and their families in understanding and managing their condition. It gives an insight into the formation of a focus group in the west Midlands called Focus on Asians with Diabetes (FAD), and the various initiatives that it has been involved with. The FAD group's aim is to improve the knowledge, understanding and management of diabetes in the Indo-Asian population using multimedia resources, and therefore promoting an improved quality of life. The challenges and dilemmas faced by the group when completing the projects undertaken and ensuring that they were culturally sensitive to meet the needs of Asians with diabetes are highlighted in this article.

KEY WORDS

* South Asians

* Focus group

* Cultural sensitivity

* Multimedia resources

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South Asians comprise around 3% of the UK's population, according to the National Statistic's 2001 census (Figure 1). Most Asians living in the UK come from India, Bangladesh, Pakistan and East Africa.

Diabetes is a growing problem. Estimates suggest that there are currently about 120 million people worldwide with diabetes and that this number is set to double by 2010 (Diabetes UK, 2000). Koppiker and Rao (2003) state that countries with the largest number of people with diabetes in 1995 were anticipated to remain the same by the year 2025, although numbers of people with diabetes would increase; India (19 million to 57 million), China (16 million to 38 million) and the US (14 million to 22 million).

Diabetes has particularly increased among south Asians in the UK, of whom 20% over the age of 40 years have type 2 diabetes (Barnett, 1999). The prevalence of diabetes is 15.2% in Asian communities in comparison with the white population in which the prevalence is only 3.8% (Burden, 2001). The prevalence of diabetes varies within the south Asian community. Shaikh et al (2001) suggest that diabetes affects over 20% of Muslims. Patel et al (2001) state that diabetes affects over 15.2% of Hindus.

A population survey carried out with 4395 Asian residents, by Simmons et al (1992) in Coventry, highlighed that 94% of the population were Punjabi Sikhs, Punjabi Hindus, Gujarati Muslims, Gujarati Hindus and Pakistani Muslims. Many of the participants will be from the Indian subcontinent around the world, which has a huge diversity of people with 14 major languages with approximately 100 different dialects.

Background

Many barriers prevent healthcare professionals from delivering effective education and a good quality of care to the UK's ethnic minority population from south Asia. The term 'Asian' suggests a single cohesive group, but in reality the communities are from different countries and social classes, with different languages, religions and traditions (Marwa, 2000). Diversity in language, religion, cultural norms and expectations prevents effective communication, which creates misunderstanding between the majority and minorities (Ahmed and Atkins, 1996)

Burden (1998) suggests that the prevalence of diabetes is four times higher in Asians than in Caucasians and argues:

  '... that many health professionals tend to group all Asian patients
  together and generalise their care.'

It has been estimated that in the UK there are over 2 million people who speak very little or no English, and the majority of these people are Asians (Mello, 1992). This can pose problems for healthcare professionals in the delivery of effective healthcare services in order to meet the needs of the patient. Asians who have migrated to the UK vary considerably in their literacy skills; a sizeable minority are unable to read either their own language or English (Karseas and Hopkins, 1987). Educational literature that is written in different Asian languages will not meet the educational needs of the South Asian community that are illiterate. Cultural and communication difficulties make this group more resistant to healthcare implementation strategies. Many healthcare professionals who care for Asian people with diabetes find it difficult to educate their patients with diabetes on how to accept and manage their condition. According to Vass (2003), patients will do well with compliance and will be more satisfied with their care if they fully understand their illness.

Chandola (2001) highlighted that Pakistani and Bangladeshi respondents had the poorest self-rated health. The poorer health of south Asians compared to the white population may be due to factors related to occupation, social class, material living conditions and local area deprivation.

The British Heart Foundation (2001) has highlighted the following points:

* South Asian men smoke more than the general population, particularly Bangladeshi men.

* As a community, south Asians eat the least fruit and vegetables of all ethnic groups.

* South Asian men and women are less likely to participate in physical activity than the general population.

* South Asian men and women are more likely than the general population to have central obesity (when fat is centred around the waist), placing an extra strain on the body and heart.