Diabetes as a Serious Health Issue in Many Developed Countries - Research Paper Example

? Impact of Diabetes among the Lebanese Community in Sydney Diabetes is a serious health issue in many developed countries, including Australia. The fact that the disease is more prevalent among certain cultures or those of certain ethnic backgrounds is also not a new phenomenon. Though genetics may play a part in some instances, many ethnic groups also tend to retain cultural habits of previous generations, which may lead to a higher incidence of Diabetes or difficulties in Managing the disease. The incidence of Diabetes in the Lebanese population, who has immigrated to Australia, is the focus of this study. Available research indicates that the incidence of Diabetes is much higher in people who are not born in Australia and that utilisation of heath care services in much lower. A qualitative research study has been conducted among Lebanese immigrants living in Australia, to identify the most common factors contributing to the higher rates of Diabetes among this population. This study focuses on many factors, including diet, self-efficacy in taking prescribed medications and the psychological influences on disease outcomes. Some key findings suggest that the Lebanese population in Australia might benefit from Diabetes education and dietary consultation, which is more culturally relevant. Those within the Lebanese population, living in Australia, tend to retain many of their cultural practices that are widespread among their ethnic group, including dietary habits. In addition, cultural attitudes toward disease tend to have a negative effect on how those within the group view themselves, when they are diagnosed. Keywords: Diabetes prevention, disease risk factors, dietary habits, Diabetes education, health disparities among minority populations, dietary guidelines, Lebanese population in Australia, psychological impact of disease, food choices. Introduction The increasing incidence of Diabetes among Lebanese people living in Australia is cause for concern. Sydney is host to a large number of Lebanese people, migrated to the country, hence the city, in search of better job opportunities living standards. There are many studies indicating increased prevalence of diabetes mellitus in these families. ABS data shows that in 2004-05, among persons born overseas, rates of diabetes were highest for persons born in Southern and Central Asia (8.7%), North Africa and the Middle East (6.6%), South East Asia (5.7%) and Southern and Eastern Europe (4.9%) (after adjusting for age differences). By comparison, the rate of diabetes for persons born in Australia was 3.3% (ABS 2006). This phenomenon has been ascribed to influence from heredity, food choices and eating habits, the prevalence of Metabolic Syndrome and increased consanguinity over many generations (Abou-Daoud, 1969). Practices that adhere to cultural norms of the specific population can have a great impact on the prevalence and management of disease. Acculturation is a social process in which those of various cultural and ethnic backgrounds, born outside the country where they currently live, adopt new cultural norms, that are more like those of the people native to the country in which they live. The level of acculturation is affected by community, family and social life. It can greatly influence the impact of disease on a family and the quality of life of an individual within the family and community (Dept. Human services (Vic), 2004). Food preferences, use of health services and attitudes toward Diseases are influenced by levels of acculturation. Diabetes in any population is associated with increased mortality, morbidity, economic, cultural, and social impacts on the person, family, relations, and the community (Zalloua, 2003). Therefore exploration into these factors can discover the qualitative indicators that are impacted with diabetes in this population. A greater understanding of the cultural influences on outcomes for those with Diabetes, along with the impacts of the disease, may allow researchers and health workers to develop initiatives that change these perspectives of Diabetes amongst Lebanese population. Exploration of the management of diabetes will be also be taken into account, as well as its effect on the individual. Literature Review Risk Factors for Developing Diabetes Mellitus The key risk factors of diabetes are obesity, particularly abdominal obesity (Haffner, 2009), unhealthy diet, ethnic-specific food habits, genetic predisposition indicated by family history, age and physical inactivity (Shaw & Chisholm, 2003) as well as reduced HDL cholesterol, raised triglycerides and increased blood pressure (International Diabetes Federation, 2009). In comparison to Australian-born residents, migrants have demonstrated greater indicators of obesity – body weight, percentage of body fat mass, basal metabolic index, and waist and hip circumference (Hodge et al., 2004). While no statistics are available on the Lebanese community in Australia, findings on the population of Lebanon show that some 46.6% are obese, 36.6% are overweight (El Bcheraoui & Chapuis-Lucciani, 2008), and that adults, especially older, single, female, widowed, divorced, and less educated Lebanese, do little to no regular physical activities or exercise play. In addition, Bhargura (2004) identifies stress related to acculturation as another factor influencing the prevalence of Diabetes within the Lebanese community. Combined, these Factors suggest that the Lebanese immigrant population of Australia may be inordinately susceptible to Diabetes, requiring aggressive intervention. Impact of Diabetes on Life and Quality of Life The impact of diabetes is all-encompassing and its effects on daily life, work life, and social relationships represent a significant impairment of quality of life (Ferzacca, 2000), which may cause individuals to feel disconnected (Aikens et al., 2008). For migrants who are already alienated from the mainstream, the impact of these may be too large to handle. Fatigue, the need to go to bed early, fear of losing their job and loss of interest may contribute to lost opportunities for social interaction or compromise their quality and frequency. Many diabetics experience difficulties in communication and memory lapses may affect conversation further by exacerbating irritation and stress (Broom & Whittaker, 2004). As of yet, nothing is known about the impact diabetes has specifically on the quality of life of Lebanese diabetics living in Sydney. Diabetes in the Lebanese Community Studies on various ethnic groups living in Australia indicate that immigrant populations and their families utilise health services at a much lower rate than the mainstream population. The limited research available on the burden of disease, within ethic population, does little to improve outcomes. Racial and ethnic origins determine incidence, prevalence, severity and outcomes of Diabetes, due to risk factors, such as obesity, physical inactivity and high fat diet (Wong, 2005). Though research on specific disease is limited; it is a well established fact that Australian residents originating from Middle East countries have a higher incidence of Diabetes and a higher prevalence of associated risk factors. A number of family studies have been conducted in the Lebanese population in Australia. Findings indicate that members of this population tend to retain their own cultural identity, even though they have migrated to another country (Knafl and Gilliss, 2002). Habits and lifestyle are an important part of cultural identity. Therefore food choices, dietary habits and levels of physical activity will tend to reflect cultural norms. Little is truly known about the effects of Diabetes on this population. Kolb (2000) contents that while this community suffers like any other population, it may not view an aggressive action toward disease as a means of improving quality of life. Because there is little known about specific diseases affecting the population, some observations about other health issues or problems may hint at a connection to Diabetes. It has been observed that there are a high number of observed deaths of unknown aetiology in the Lebanese population during infancy and childhood (Medlej, 2004). These deaths may be due to undiagnosed acute complications of insulin-deficient diabetes mellitus, particularly diabetic ketoacidosis, pointing to effects in the family of grief and sorrow. In order to develop effective programs to address Diabetes in the Lebanese community, research must focus on the cultural and social views of the disease, as well as the social, economic and emotion impact it has on community members. Methodology The high incidence of Diabetes among the Lebanese population of Sydney indicates a pressing need to identify their ethno-specific risk factors and to determine treatment and intervention approaches. For the purpose of the Masters degree, a qualitative study was conducted to explore the experience of diabetes among Lebanese living in the Sydney Metropolitan area. 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. 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. Permission was obtained from the local surgery in order to recruit eligible participants of the study. Data were collected using in-depth interviews focusing on participants’ experience of diabetes, side effects, management and control of the disease. The study also explored the history, complications, disease management and its impact on quality of life and psycho-social well-being among the Lebanese population of Sydney. Thematic analysis of the in-depth interviews revealed participants’ attitudes, perceptions and beliefs regarding the disease, their experience of diagnosis, management and treatment of diabetes mellitus. Interview Questionnaire Q1. Please tell us your experience of diabetes. How old were you when you were diagnosed with diabetes. Q2. How was your Diabetes diagnosed? Q3. How has being diagnosed with diabetes affecting your physical health? How has being diagnosed with diabetes affecting your emotional/mental health? Q4. What were the complications and side effects once diagnosed with diabetes? Q5. Have you been involved in designing a treatment or care plan for managing your diabetes. Please describe. Q6. Have your diabetes medical advisors discussed any treatment options with you? If so, what were these alternative treatments? Q7. What do you find most difficult about your diabetes? (Check all that apply). Healthy diet Exercising Doing injections Testing glucose levels I don’t find anything difficult Other, please specify ______________ Q8. Why do you find it so difficult? Q9. Do you feel different than other people because of diabetes? Q10. How has diabetes had an impact on your quality of life and well-being? How has your life changed since being diagnosed with diabetes? Q11. Discuss how diabetes impacting on your: Economic life Family life Social life 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 . 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 their voluntary participation. Written consent was sought from the participants for the in depth interviews. 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. Results Diagnosis of Diabetes The first question in this survey simply asked patients to list the age at which they were diagnosed with diabetes. The participants in this group were diagnosed with Type 2 diabetes at ages ranging from 40 to 50, the youngest being a woman who initially developed Gestational diabetes during a pregnancy. Answers referring to the diagnosis of the participants show a trend that most people are unaware that they even suffer from the disease until they are diagnosed by a medical professional. Participants were asked how they were diagnosed with diabetes with the second question of the survey. Almost half of the surveyed group – forty-eight percent – went to their general practitioner based on symptoms that the patients recognized as possibly being linked to Diabetes, because of family members with the disease or for symptoms ranging from wounds that would not heal to dizziness to rapid weight loss or gain. Glucose tests were then performed to diagnose the disease. Conversely, the other fifty-two percent of the participants were surprised by a diagnosis of diabetes. They were diagnosed because of other health problems, due to diagnostic tests for other illness and through routine blood testing. Treatment of Diabetes Participants in this survey were asked in questions five and six whether they actively took a role in designing their treatments plans and if alternative treatment options were discussed. Almost half of the participants stated that they played no active part in their treatment for a variety of reasons. One of the main factors identified for lack of participation was lack of communication between physician and patient, due to language barriers. Even when patients understood what they provider was explaining, it was often approached or viewed as giving the patient a set of orders, rather than as a give and take discussion, with patients being involved in the decision making process. Another factor was identified as the differences in foods of Lebanese and other cultures. There is some difficulty understanding which foods within the culture may be considered preferable and the types of foods that health professionals recommend. Table 1, Participant Challenges of Managing Diabetes, in the Appendix, demonstrates the incidence of each challenge, by comparison of the number of respondents. Effect of Diabetes Physical Health All patients who suffer from diabetes deal daily with multiple physical symptoms and side effects of the disease. This survey is no different in this regard, from the rest of the population. Questions three and four asked participants about how their physical health was affected by diabetes, including complications and side effects due to treatment of the disease. The most frequent response to the question is fatigue, followed by high blood pressure, high cholesterol, frequent infections, vision disorder and weight gain. At least twenty percent of participants reported having one of the sic side effects listed above. In addition to fatigue, vision complications was reported as the second leading complication. Psychological/Mental Health The second part of the third question in the survey asked specifically about the participant’s emotional health. Eighty percent of the participants expressed feelings of depression, shame, anxiety, worry, and/or fear with depression and fear being the most commonly felt emotions. A feeling of helplessness is also felt by both genders of participants. Women suggest that they already have too many responsibilities of cooking, caring for the home and raising children, to look after themselves properly. Male participants frequently mentioned the need to urinate frequently, as an embarrassment when they are among co-workers. Social Health Frequently, in answers to question three and randomly through the sample, participants stated they had feelings of alienation or isolation from other members of their community. Only three of the twenty-five diabetic participants reported that they suffered no significant emotional problems as a result for their diagnoses. Lebanese families also consist of many members. Many participants believe it is unreasonable to expect different foods at the table for one family member. Many have admitted to avoiding visiting friends and relatives, due to special dietary Needs. Questions nine, ten, and eleven all ask participants whether they feel different from people who do not have diabetes and how the disease has affected their quality of life, particularly economically and socially. Seventy-six percent of the participants feel isolated and different from those not suffering from diabetes. Most are uncomfortable or embarrassed by tiring easily and frequent urination and are resentful that others do not have to watch what they eat. Ten of the participants stated that they suffer a significant loss of income due to their inability to work and the expense of treating their diabetes. Five participants state that their illness has caused family problems but on the positive side, sixty-eight percent of the participants state their illness has no effect on their family life and in two of these cases participants actually stated that their families are very supportive. Discussion Diabetes is a serious disease that has a great impact on the Lebanese culture living in Australia. However, unlike mainstream cultures, Lebanese immigrants face many unusual challenges that other may not. Cultural norms may prevent them from some activities that can be beneficial in controlling Diabetes. Lack of understanding about dietary preferences, which are embedded in their culture, make it difficult for patients to adhere to suggested dietary changes and difficult for health providers to make viable recommendations in food alternatives or dietary changes. While large extended families are not unique to the Lebanese culture, combined with cultural customs, foods unique to the culture and perceptions about major diseases, they serve to reinforce the negative social repercussions that occur with the presence of Diabetes. Feelings of shame, guilt and isolation are reinforced by cultural norms. Lack of support from family members and the community are due largely to having little understanding of how Diabetes affects the body and the need for lifestyle changes. Implications While all diabetic patients typically suffer from one or more symptoms, it appears that those who adhere to strict cultural practices may suffer more than others, in many ways. Little prior research is available, to identify the particular challenges of Diabetes unique to the Lebanese culture living in Australia. This research was designed to shed some light on the various challenges the culture faces and hopefully, to consider such unique challenges, in the development of health education programs, targeted health services and health policy. Health education programs should focus on dispelling myths and eliminating the prejudices that the culture may have, toward those diagnosed with Diabetes. Education efforts would be more effective if they are presented by someone the community feels comfortable with. Nurses and physicians within the culture hold the most promise in educating the community about the need for self management activities, with a diagnosis of Diabetes. It is evident that among the Lebanese culture, there is a need for health providers to become more knowledgeable about cultural practices, particularly with respect to dietary habits, preferred foods and exercise. Physicians and nurses should become more culturally competent, not just to serve the Lebanese population, but to better serve other minorities in Australia as well. This is also the case for many EU countries and the United States, where access and utilization of health care by minorities is shown to be poor (Szczepura, 2004). Training of health care staff to serve specific populations is one approach that can help professionals become more culturally competent. Patients respond better to health care professionals who speak their language and understand their culture and patient participation is higher when health care workers communicate effectively with patients (Glasgow et al, nd). Relying on a more diverse staff in local and regional health care facilities may also help improve response to health care services. Because cultural norms make getting a suitable level of exercise difficult for many, Programs that incorporate activities of daily living should be considered. Women and men within the culture have their own ways of socializing and these aspects may also be incorporated into exercise programs. A local women’s gym for Lebanese women that is open during school hours and that offers child care is one example. Men might benefit from a facility that is open early in the morning, during the lunch hour and after work. There is no single solution in addressing the incidence of Diabetes among the Lebanese population in Australia. It is best approached from many angles, considering culture, language and social barriers that affect outcomes for those diagnosed with Diabetes. References Glasgow, N., Sibthorpe, B. & Gear, A. (nd). Primary health care position statement: Scoping of the evidence. Retrieved from http://www.agpn.com.au/__data/assets/pdf_file/0005/16268/20051026_pos_AGPN- Primary-Health-Care-Position-Statement---A-scoping-of-the-evidence-FINAL.pdf. Szczepura, A. (2004). Access to healthcare for ethnic minority populations. Postgraduate Medical Journal, 81, 141-187. Appendix Table 1: Participant Challenges ______________________________________________________________________________ Participant Challenges in Diabetes Management (n=25) ______________________________________________________________________________ Exercising 12 Glucose testing 9 Healthy diet 9 Injections 8 None 1 Read More