Culturally sensitive health education about type 2 diabetes needed
A significant public health issue is type 2 diabetes (T2D). Its prevalence has dramatically increased globally, including in Finland and other Nordic countries. T2D is linked to several comorbidities in addition to being a significant risk factor for microvascular and macrovascular diseases. Ethnic minority groups need more culturally sensitive health education because they may have different beliefs and traditions concerning health.
The growing burden of chronic diseases, especially T2D, among immigrants and ethnic minorities poses a serious public health challenge for many European countries (Agyemang et al., 2021). Since the influx of immigrants is on a steady increase, proper measures need to be put in place to avoid increase in economic costs on the national health care system. Trust in health care and the health education provided by its staff should be strengthened. When proper measures in a culturally sensitive way are put in place, this can help slow down the prevalence rate of T2D among the African migrant population.
In contrast some studies have previously shown that arriving immigrants generally have better health status and even longer life expectancy than others in the home country, which is often referred to as ”the healthy-migrant effect”. However, these advantages often disappear with subsequent acculturation and socioeconomic disadvantages later in their lives. Studies also highlighted social inequalities and health care issues, with regards to immigrant populations in Nordic countries. This may be related to the concept that Nordic countries’ universal welfare systems provide free health care to all. (Debesay et al., 2022; Helgersson et al., 2019.)
No symptoms, no visits in health care
Among many ethnic minority groups disease is not considered a problem unless it is accompanied by symptoms that prompt one to seek medical attention and that call for treatment, such as fever, diarrhea, pain, and cough. For example, among African minorities it is likely for people to go undiagnosed with most chronic diseases such as T2D until complications arise. Because cardiovascular risk factors including a sedentary lifestyle and improper diet do not constitute conditions that are immediately life-threatening or anxiety-inducing, the adoption of preventive health measures is not motivated by any urgent health demands. (Issaka et al., 2013.)
Misconception and lack of proper knowledge
T2D is a serious, long-term condition. It occurs when the body does not produce enough insulin or does not use the insulin effectively, resulting in elevated blood glucose levels (Diabetes atlas, 2021). As the aetiology of T2D is not fully understood, this as a result has led to many not paying attention to healthy life choices in the prevention of T2D. It is believed by many that people get T2D because they consume a large portion of sugary diets. The perception held back home may be that once you are diagnosed with T2D, you have a few years to live and the perception that the afflicted patient consumed large amounts of sugar or sugary product which led to the person having diabetes.
For instance, most local Ghanaian Languages translates “Diabetes” as “asitsire yare3” meaning “sugar sickness”. For this reason, many who barely eat sugary stuff wouldn’t think they can ever have T2D since they are not eating sugar or candies unknowing most of our food which happens to be carbohydrates breaks down to glucose after the end of metabolism.
As the aetiology of T2D is not fully understood, this as a result has led to many not paying attention to healthy life choices in the prevention of T2D.
In many African countries, such as in Ghana, some people prefer to seek spiritual intervention for chronic ailments that are supposed to be treated medically. They mostly visit prayer camps and other religious entities that claim to heal various chronic ailments. This practice has also had effect on some immigrants abroad. Notwithstanding the fact that it isn’t a common practice abroad to seek spiritual intervention, a handful of immigrants still seek spiritual intervention when the ailment becomes chronic, in some instances not giving the same attention to its treatment medically.
Fear of being judged or prejudice
There is also an issue of being shy talking about an ailment or discussing our health issues openly or with health care professionals. Many immigrants do not feel comfortable even discussing their health challenges with health professionals due to the negative stereotype associated with certain health challenges among the African immigrant community.
In instances where the patient needs interpretation, they are often reluctant to use the services of an interpreter because of shyness and due to the notion held that their health status may be known by a third party and their privacy has been violated. Therefore, it is important that patients can trust the health care professionals’ and interpreters’ professionalism and confidentiality. Patients should get information in a culturally appropriate way and health education should be given considering the cultural background. (Eklöf et al., 2019.) However, even culturally sensitive topics should not be left undiscussed.
Agyemang, C., Van Der Linden, E. L., & Bennet, L. (2021b). Type 2 diabetes burden among migrants in Europe: unravelling the causal pathways. Diabetologia, 64(12), 2665–2675. https://doi.org/10.1007/s00125-021-05586-1
Appoh, L., Felix, F., & Pedersen, P. U. (2020). Barriers to access of healthcare services by the immigrant population in Scandinavia: a scoping review protocol. BMJ Open, 10(1), e032596. https://doi.org/10.1136/bmjopen-2019-032596
Debesay J, Nortvedt L, Langhammer B. (2022). Social Inequalities and Health among Older Immigrant Women in the Nordic Countries: An Integrative Review. SAGE Open Nurs. 2022 Mar 14(8):23779608221084962. https://doi.org/10.1177/23779608221084962
Eklöf, N., Hupli, M. & Leino-Kilpi, H. (2020). Factors related to privacy of Somali refugees in health care. Nursing Ethics 27(2), 514–526. doi:10.1177/0969733019855748
Gabarron, E., Bradway, M., Fernandez-Luque, L., Chomutare, T., Hansen, A. H., Wynn, R., & Årsand, E. (2018). Social media for health promotion in diabetes: study protocol for a participatory public health intervention design. BMC health services research, 18(1), p. 414. https://doi.org/10.1186/s12913-018-3178-7
Helgesson, M., Johansson, B., Nordquist, T., Vingård, E. & Svartengren, M., 2019. Healthy migrant effect in the Swedish context: a register-based, longitudinal cohort study. BMJ Open 2019;9:e026972. doi:10.1136/ bmjopen-2018-026972
Issaka, A. I., Agho, K. E., Burns, P., Page, A., & Dibley, M. J. (2015). Determinants of inadequate complementary feeding practices among children aged 6–23 months in Ghana. Public health nutrition, 18(4), 669–678. https://doi.org/10.1017/S1368980014000834
Timm, L., Harcke, K., Karlsson, I., Annerstedt, K. S., Alvesson, H. M., Saleh-Stattin, N., Forsberg, B. C., Östenson, C., & Daivadanam, M. (2020). Early detection of type 2 diabetes in socioeconomically disadvantaged areas in Stockholm – comparing reach of community and facility-based screening. Global Health Action, 13(1), 1795439. https://doi.org/10.1080/16549716.2020.1795439
Recommendations for health promotion among immigrants
Visual and language-based information should be made available to immigrants with low levels of education and those who cannot read.
Community-based screening has greater potential than facility-based screening in targeting individuals who are not actively seeking care (Timm et al., 2020).
More research into the types of barriers that immigrants encountered while interacting with healthcare professionals and healthcare systems, as well as strategies for overcoming them (Appoh et al., 2020).
Social media platforms have been proposed as successful instructive medium through which to advance auxiliary avoidance measures and conduct change (Gabarron et al., 2018).