Diabetes among Immigrant Populations - Research Paper Example

? Methodology Overview Immigrant cultures often retain the customs and habits of previous generations, the level of acculturation varies among different immigrant groups. Available research indicates a higher incidence of Diabetes among immigrant populations living in Australia, with a higher incidence in for those born in Asia, the Middle East and Southern and Eastern Europe (ABS, 2006). Though the higher incidence can be at least partially attributed to genetic and hereditary factors, such factors do not provide an adequate picture of the increased incidence of Diabetes. Much of the explanation involves acculturation, or the level in which an immigrant population takes on habits and characteristics of the native or local population. Of particular interest is the Lebanese population living in Sydney. Much of the Lebanese population in the region is aware that Diabetes exists and many within the Lebanese community know what the disease is, through associated with family members and friends who have the disease. However, many barriers appear to exist in achieving a greater level of control of this serious health issue. There are also many barriers to prevention, that appear to be prevalent, among members of the Lebanese community in Sydney. In order to obtain a more thorough picture of how the Lebanese population views the health issue and assess what it knows about Diabetes, a research study has been conducted. It is hoped that results of the research will provide greater insights into the challenges in preventing and managing Diabetes, within the Lebanese immigrant population, living in Australia. Data can then be used to develop local or regional education and prevention programs that address the particular needs of the Lebanese population. Research Design Descriptive research Due to the challenge in assigning a value to beliefs, psychological factors and personal knowledge about Diabetes, an interview questionnaire was used to obtain data for the survey, using open ended questions that allowed sample members to speak freely about their experiences. The research survey has been conducted as a descriptive qualitative study, which focuses on experiences and individual factors that may influence outcomes of those diagnosed with Diabetes. “Descriptive research provides data that looks at the effect of having the health issue” (Crosby et al, 2006). Descriptive research is that which gathers information about a current condition. There is an emphasis on describing the condition, rather than on judging or interpreting results. The open-ended questions allow for study participants to provide answers that involve physical, emotional and psychological effects of having Diabetes, in the Lebanese culture. It is an experience that may be unique to this population, considering the unique features of the Lebanese culture. Descriptive research seeks to verify an existing hypothesis, related to the current condition. With respect to the Lebanese culture and the incidence of Diabetes, it is hypothesised that many cultural influences have a great impact on the incidence and management of the disease. Descriptive research focuses on explaining a current condition or issue in detail, allowing for a complete picture into how the condition is influenced, by a variety of factors. With respect to the local Lebanese population, descriptive research allows the researcher to gain a broader perspective into how Diabetes affects the individual, family, relationships, work, economic status and lifestyle of each participant. It also provides a picture of how each of these factors may influence the prevalence and management of Diabetes within the specific population. With descriptive research, the researcher typically has an idea of the kind of understanding or knowledge to be gained. Knowing how various members of the Lebanese community feel about Diabetes and their beliefs surrounding the disease can provide the researcher with ideas on where barriers to understanding and managing the disease lie.   As the purpose of this study is to gain a more thorough understanding of how Diabetes affects the lives of members of this culture, and why prevalence is so high, descriptive research allows for a variety of views from participants. Such views can then be compared and contrasted in analysis. The experiences of each participant are considered. This provides an opportunity for identification of recurring themes or issues, that may lead to further investigative research or to effective education and prevention programs, among the Lebanese culture. It also affords the researcher a level of control, by conducting personal interviews with participants, which may not have been possible with other forms of research, such as a quantitative survey that simply collected data involving measures. Due to the need for interpreters with many survey interviews, the researcher can ensure that the interpreter is asking the right questions in the appropriate manner, by being present in personal interviews. Finally, descriptive research includes a measure that prevents researcher bias, as the words participants are recorded exactly how they are spoken. Qualitative methods Qualitative methods are those that can be more readily used to explored attitudes, perceptions or beliefs about a situation and the impact that the situation has on the lives of the study population. These are factors that are difficult to place a specific numeric value on. The in-depth interview questionnaire includes questions regarding Diabetes experience, medical history, complications and side effects, disease management and impact on quality of life or well being for the patient. Questions administered to participants include those that are open-ended, which allow participants to provide responses without limitations. “Qualitative methods typically produce a wealth of detailed data about a defined number of people and cases” (Patton, 2002). Participants may share their experiences when attending social gatherings, from a Physical perspective and emotional perspective, with respect to how Diabetes has affected their lives. They may talk as much about the experience of social relationships, as they do about physical comfort in social situations. Qualitative research offers some benefits over other methods, in obtaining information that is honest and includes emotional or psychological factors, influencing a particular issue or problem. In obtaining information about how Diabetes may affect economic status, family relationships and other social aspects of the disease, asking direct questions in a quantitative study may not elicit the most honest responses. Participants may become offended or embarrassed when asked if their health issues have created financial difficulties or problems with family relationships. Asking participants to rate those effects may further cause hesitation in providing an honest response. If a respondent talks about his or her Diabetes causing inability to work, this can indicate as much of an understanding about economic impact as rating a person’s economic situation. “Qualitative methods are particularly well-suited to exploration, discovery and inductive logic” (Patton, 2002). With qualitative research, the aim is to identify common or recurring themes. Participants who are not directly asked about how much Diabetes has impacted their economic situation may be more open in sharing such information. When respondents are allowed a unique voice, they believe their opinion counts and may be more willing to share their experiences. One of the benefits of qualitative research is “the Ability to interact with the research subjects in their own language and on their own terms” (Kirk & Miller (as cited in Matveev, 2002). With use of an interpreter, the researcher can conduct qualitative research that interprets the interaction, as well as the responses to questions. Sample and Participants Permission was obtained from the local surgery in order to recruit eligible participants of the study. In-depth interviews focusing on their experience of diabetes, its side effects and management of the disease was carried out amongst 25 participants, aged between 40-55 years, who had been suffering from Type 2 diabetes for more than six months. The qualitative approach also explored their attitudes, perceptions or beliefs of diabetes, and the effects the disease was having on their lives. Since the qualitative study was based on a small sample (N=25), no reliable generalisations for the larger Lebanese community in Sydney or elsewhere or for other ethnic groups with similar characteristics can be extrapolated from the findings. However, these findings have suggested areas of relevance that should be investigated further among a larger sample. Though the sample size is relatively small, participants from the Lebanese community were able to provide some very genuine and honest concerns surrounding living with Diabetes. They were able to provide information and insights on a deeper level, which may not have been available through a paper survey of a larger population. The purpose of the research is to explore cause and effect and recurring themes, for potential future research topics and education programs. If a paper survey were administered to a larger Lebanese population, throughout Australia, for example, each participant might still require the use of an interpreter, at great expense. Logistically, administering a pen and paper questionnaire on a larger scale would create far greater need for phone contact with clinics and health care providers, a longer time for gathering of survey results and possibly a far lower rate of response. Reliance on health care clinicians, who may already be overworked, might result in missed opportunities for qualifying participants. Furthermore, health care providers and clinicians might identify participants who may not fall into the sample characteristics, such as age, duration of disease and specific ethnic group. Because quantitative data tends to rely more on representative samples of a population, participants should be randomly selected. While a population in a qualitative research study might also be representative of a population, conclusions and judgements about the population, as a whole, are not being made. The discovery of themes and personal experiences requires a more hands-on approach. This makes random sampling challenging, if not outright impossible. There are some parameters that still must be used, in selecting the characteristics of research participants. For this study, the age group was determined, based on the typical age in which Diabetes is diagnosed in the general population. “Type II Diabetes tends to develop slowly, later in life, usually after the age of 35 years” (Diabetes Australia (Vic), 2002). The age group of the sample therefore, represents a typical age range in which Diabetes may be discovered in adults. Obtaining data from a larger group posed to be somewhat of a challenge. Much of this is due to language barriers. Without an interpreter to explain the research study to participants, many potential respondents were hesitant. However, it is believed that, for the purpose of this study, a sample size of (N=25) is sufficient, as open ended questions tend to elicit responses that take plenty of time and require communications back and forth, from interviewer to interviewee, often through an interpreter. Sydney was chosen as the site or region to conduct research, as it is large enough to provide a sample of the Lebanese population and to provide interpreter services, when necessary. Close proximity to the University of Sydney allows for consulting on various aspects of research and design and access to volunteers, who were willing to serve as interpreters. Data Collection Data collection was carried out using an interview questionnaire, given to 25 consenting participants, who are patients at the local surgery in Sydney, diagnosed with Diabetes for at least six months and who are of Lebanese origin. The 11 questions administered focus on the impact Diabetes has had on the lives of the patients in the sample. Impact can include social, psychological, financial and cultural dimensions. Interviewees provided open ended responses for 10 of 11 questions. Ethical approval was obtained from The University of Sydney. This research was approved by the Human Research Ethics Committee and permission for interviews and recordings was gained from participants. Furthermore, ethical issues in this study involved the assurance of confidentiality and autonomy for the participants. All participants were informed of the purpose and design of the study and of their voluntary participation. Written consent was sought from the participants for the in depth interviews. Each participant was interviewed separately and a determination was made prior to each interview, as to whether the use of an interpreter was necessary. Responses to questions were recorded verbatim, so that the experiences of participants could be included in an unbiased manner. Procedures Initially, the local surgery in Sydney was contacted, to gain permission to interview Lebanese patients diagnosed with Diabetes. When permission was granted by the local surgery, approval of the Human Research Ethics Committee and the University of Sydney was then granted. Local surgery patients were then identified, using data extraction techniques, who matched the criteria for the study, such as ethnic origin, age and diagnosis of Diabetes for at least six months. While data extraction typically uses a set of parameters to identify particular groups with common characteristics (Jones), which is technology based, the automated patient record system does not recognize length of diagnosis as one of the parameters. Therefore, extraction of patient data by diagnosis was completed, then potential participant individual health records were reviewed, to determine eligibility by length of diagnosis. Patients were contacted and asked to participate. At the same time, the purpose of the study was explained, as well as patient rights, such as voluntary participation and protection of personal information. Patients who did not agree to participate were then removed from the list of potential survey participants. Each patient who agreed to participate was also asked if the use of interpreter services would be required and arrangements were made for an interpreter, either from the University of Sydney or by the patient. Questions in the study were asked of each participant, in a methodical order. Each participant questionnaire was labelled with a participant number, such as participant 1, participant 2, etc., to protect patient identity. Responses were recorded onto the questionnaire at the time of the interview, to ensure integrity of data collected. Data Analysis The method of analysis for this study is qualitative description, meaning information based on descriptions of experiences and events. This provides for an analysis that can be explained in day-to-day language, summarising events and what they meant to participants. Specific patterns and themes were identified from the answers given that provided an accurate summary of the experiences of this group and their shared disease. The information identified was then used to surmise methods of improvement so that the overall experiences of other people in this ethnic group suffering from diabetes become more positive and much less frustrating. After all the questionnaires were gathered, the researcher then reviewed responses to identify common themes, such as common or similar responses to the question about the age of diagnosis, the emotional challenges patients discussed and the physical limitations patients might describe, for example. Some questions elicited responses that were used in a combined manner, to determine average age of diagnosis, the variations in age of diagnosis and the most common challenges facing patients diagnosed with Diabetes. The second part of question 1 asked participants about specific age of diagnosis. Question 7 asked participants which of the following were the greatest challenges of Diabetes: healthy diet; exercising, giving injections; testing glucose levels and not having any challenges at all. Responses to the second part of question one, age of diagnosis, indicate a need for education and greater understanding of how to prevent Diabetes. While most participants responded that they were diagnosed between the ages of 40 and 45, there were a few who were diagnosed in their 30s. Responses to question 7 indicate that eating a healthy diet is the greatest challenge for participants. While exercising and giving injections both rank high on the list as well. A total of 12 participants selected eating a healthy diet as a challenge, while exercising and giving injections both were selected by 9 participants. Checking blood glucose levels was a challenge for a few participants and one had no challenges in managing and dealing with the diagnosis of Diabetes. Some common themes in responses to other questions have also been identified. Many participants mention the difficulty in eating a healthy diet, within the foods preferred by their culture. Of significance, was the common mention that physicians and health care professionals, who lack an understanding of the types of foods common in the Lebanese culture, often made recommendations for foods that participants would normally not eat. This common theme suggests a need for cultural competence training for clinicians and health care providers. "In nutrition counselling, where many therapeutic interventions are on a personal level, sensitivity to the strong influence of culture on an individual's food intake, attitudes, and behaviors is especially imperative" (Florida International University). Those who are in a position to advise patients about dietary changes, should having knowledge of the types of foods commonly used in various cultures and their nutritional values. Two additional themes identified are also related to food and dietary concerns. Some participants described the difficulty in as avoiding certain foods or replacing them with those that were suggested by health professionals, due to the large size of their families and challenges in preparing separate foods or meals. For others, avoidance of certain foods meant that they avoided social gatherings, such as with extended family and friends, as they were too embarrassed to ask for different foods to be prepared and did not want to draw attention to themselves. Again, the recognition and knowledge of commonly used foods in Lebanese culture, by health care professionals, would help patients make better choices that can ease the perceived burden on others and help them maintain social ties, where food is often a large part of the socialisation process. Ethical Considerations Due to the requirement for participation of human respondents in the research study, specific ethical issues were addressed. To protect the identification of participants, names and other identifying information, such as address, telephone and other identifiers were eliminated from research questionnaire results. Instead, each participant was given a number from 1 to 25, depending on the order in which the participant was interviewed. Elimination of identifying information, other than for initial contact or follow up purposes, is typically a requirement for approval from governing bodies that regulates protocols for human research studies. Confidentiality is important to study participants, to alleviate fears of repercussions in providing honest and open responses. During the initial process of obtaining consent from study participants, the means for keeping responses confidential were explained. In addition, the important details of the study were also explained to potential respondents, before obtaining consent. Explaining details shows respondents the importance of the particular research study and how their involvement can provide a more thorough picture or analysis of the particular issue or topic being investigated. Respondents were also advised that they could withdraw from the study at any time and that they were not required to provide answers for any specific question in the interview. References Crosby, R. et al. (2006). Research methods in health promotion. SanFrancisco, CA: Jossey Bass. Diabetes Australia (Vic) (2003). Diabetes type II: Mature onset. Retrieved from http://hnb.dhs.vic.gov.au/dsonline/ Diabetes_Type_ll_mature-onset.htm. Jones, M. (nd). Data extraction. Retrieved from http://esquiresheffield.pbworks.com/f/Extraction.pdf. Matveev, A. (2002). The advantages of employing quantitative and qualitative methods in intercultural research: Practical implications from the study of the perceptions of intercultural communication competence by American and Russian Managers. Bulletin of Russian Communication Association, 168; 59-67. Retrieved from http://www.russcomm.ru/eng/ matveev01_eng.shtml. Patton, M. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: SAGE Publications. Read More