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Culturally Tailored Resources for South Asian Immigrant Women With Gestational Diabetes: Do They Work and What’s Missing? A Qualitative Study

  • Stephanie de Sequeira
    Correspondence
    Address for correspondence: Stephanie de Sequeira MPH, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Ilana Halperin
    Affiliations
    Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Lorraine L. Lipscombe
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

    Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Published:September 28, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.09.007

      Abstract

      Objectives

      Gestational diabetes mellitus (GDM) increases the risk of pregnancy complications. South Asian immigrant women have among the highest rates of GDM in Canada and they also have the highest lifelong risk of developing type 2 diabetes after a GDM pregnancy. Diabetes Canada has been developing diabetes education material that accounts for the cultural preferences of South Asians. However, there is uncertainty to whether South Asian immigrants are aware of these resources or trust them, or if other factors influence their uptake of advice.

      Methods

      In this study, we conducted qualitative interviews to explore, among South Asian immigrant women with GDM: 1) their awareness of diabetes education resources, 2) their attitudes toward information from different resources and varying health-care providers and 3) their barriers and facilitators for GDM management recommendations. Gender theory is embedded in this study, as culturally specific gender roles regarding motherhood have been shown to be important to South Asian immigrant women and their perceptions of health.

      Results

      There was an emergence of 3 main themes. First, awareness of culturally tailored educational resources is low. Second, there is an overabundance of GDM management information, which leads to variability among participants of how they rank accuracy of informational sources. Finally, there is a gender role reversal present, where women are being taken care of by their families instead of being the providers of care.

      Conclusions

      These results indicate that better dissemination strategies for GDM educational material are needed for health-care providers and patients, and may require additional consideration of family involvement during GDM education sessions.

      Résumé

      Objectifs

      Le diabète sucré gestationnel (DSG) augmente le risque de complications de la grossesse. Les femmes immigrantes sud-asiatiques présentent le taux de DSG le plus élevé au Canada et, de ce fait, elles sont aussi exposées tout au long de leur vie au risque le plus élevé d’être atteintes du diabète de type 2 après avoir eu un DSG. Diabète Canada a conçu du matériel didactique sur le diabète qui tient compte des préférences culturelles des Sud-Asiatiques. Toutefois, on ne sait pas avec certitude si les immigrantes sud-asiatiques connaissent ces ressources et si elles y font confiance, ou encore, si d’autres facteurs influencent l’adoption des conseils.

      Méthodes

      Dans la présente étude, nous avons mené des entrevues qualitatives auprès de femmes immigrantes sud-asiatiques atteintes du DSG pour explorer : 1) si elles connaissent l’existence des ressources didactiques sur le diabète; 2) leurs attitudes à l’égard des renseignements qui proviennent des différentes ressources et des divers prestataires de soins de santé; 3) les facteurs qui nuisent aux recommandations de prise en charge du DSG et les facteurs qui les facilitent. Nous avons intégré la théorie du genre à cette étude puisqu’il a été démontré que les rôles de genre en matière de maternité sont importants pour les femmes immigrantes sud-asiatiques et leurs perceptions de la santé.

      Résultats

      Trois thèmes principaux sont apparus. Premièrement, la connaissance de l’existence des ressources didactiques adaptées à la culture est faible. Deuxièmement, le fait que les renseignements sur la prise en charge du DSG surabondent entraîne une variabilité de la valeur que les participantes accordent à l’exactitude des sources d’informations. Finalement, il existe une inversion des rôles de genre où les femmes sont prises en charge par leur famille plutôt que d’être les soignantes.

      Conclusions

      Ces résultats montrent que de meilleures stratégies de diffusion du matériel didactique sur le DSG sont indispensables aux prestataires de soins de santé et aux patientes, et qu’il convient que l’on prenne de surcroît en considération la participation de la famille durant les séances d’enseignement sur le DSG.

      Keywords

      Mots clés

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      References

        • Metzger B.E.
        • Coustan D.R.
        Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus.
        Diabetes Care. 1998; 21: B1-167
        • Feig D.S.
        • Hwee J.
        • Shah B.R.
        • Booth G.L.
        • Bierman A.S.
        • Lipscombe L.L.
        Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: A large, population-based study in Ontario, Canada, 1996-2010.
        Diabetes Care. 2014; 37: 1590-1596
        • Schmidt M.I.
        • Duncan B.B.
        • Reichelt A.J.
        • et al.
        Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes.
        Diabetes Care. 2001; 24: 1151-1155
        • Xiong X.
        • Saunders L.
        • Wang F.
        • Demianczuk N.
        Gestational diabetes mellitus: Prevalence, risk factors, maternal and infant outcomes.
        Int J Gynecol Obstet. 2001; 75: 221-228
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.
        Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        • Urquia M.
        • Glazier R.H.
        • Berger H.
        • Ying I.
        • De Souza L.
        • Ray J.G.
        Gestational diabetes among immigrant women.
        Epidemiology (Cambridge, Mass). 2011; 22: 879-880
        • Mukerji G.
        • Chiu M.
        • Shah B.R.
        Impact of gestational diabetes on the risk of diabetes following pregnancy among Chinese and South Asian women.
        Diabetologia. 2012; 55: 2148-2153
        • Diabetes Canada Clinical Practice Guidelines Committee
        Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada.
        Can J Diabetes. 2018; 42: S1-325
        • Stone M.
        • Pound E.
        • Pancholi A.
        • Farooqi A.
        • Khunti K.
        Empowering patients with diabetes: A qualitative primary care study focusing on South Asians in Leicester, UK.
        Family Pract. 2005; 22: 647-652
        • Baradaran H.
        • Knill-Jones R.
        Assessing the knowledge, attitudes and understanding of type 2 diabetes amongst ethnic groups in Glasgow, Scotland.
        Pract Diabetes Int. 2004; 21: 143-148
        • Lucas A.
        • Murray E.
        • Kinra S.
        Heath beliefs of UK South Asians related to lifestyle diseases: A review of qualitative literature.
        J Obes. 2013; 2013
        • Sohal T.
        • Sohal P.
        • King-Shier K.M.
        • Khan N.A.
        Barriers and facilitators for type-2 diabetes management in South Asians: A systematic review.
        PLoS One. 2015; 10: e0136202
        • Babakus W.S.
        • Thompson J.L.
        Physical activity among South Asian women: A systematic, mixed-methods review.
        Int J Behav Nutr Phys Activ. 2012; 9: 150
        • Grace C.
        • Begum R.
        • Subhani S.
        • Kopelman P.
        • Greenhalgh T.
        Prevention of type 2 diabetes in British Bangladeshis: Qualitative study of community, religious, and professional perspectives.
        BMJ. 2008; 337: a1931
        • Singh H.
        • Cinnirella M.
        • Bradley C.
        Support systems for and barriers to diabetes management in South Asians and whites in the UK: Qualitative study of patients’ perspectives.
        BMJ Open. 2012; 2: e001459
        • Banerjee A.T.
        • Grace S.L.
        • Thomas S.G.
        • Faulkner G.
        Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: A qualitative study.
        Heart Lung. 2010; 39: 494-503
        • Fagerli R.A.
        • Lien M.E.
        • Wandel M.
        Health worker style and trustworthiness as perceived by Pakistani-born persons with type 2 diabetes in Oslo, Norway.
        Health. 2007; 11: 109-129
        • Mian S.I.
        • Brauer P.M.
        Dietary education tools for South Asians with diabetes.
        Can J Diet Pract Res. 2009; 70: 28-35
        • Lawton J.
        • Ahmad N.
        • Hanna L.
        • Douglas M.
        • Hallowell N.
        Diabetes service provision: A qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes.
        Diabet Med. 2006; 23: 1003-1007
        • Grewal S.
        • Bottorff J.L.
        • Hilton B.A.
        The influence of family on immigrant South Asian women’s health.
        J Fam Nurs. 2005; 11: 242-263
        • Greenhalgh T.
        • Clinch M.
        • Afsar N.
        • et al.
        Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: Qualitative study using a multi-level theoretical approach.
        BMC Med. 2015; 13: 120
        • Bandyopadhyay M.
        • Small R.
        • Davey M.A.
        • Oats J.J.
        • Forster D.A.
        • Aylward A.
        Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia.
        Aust N Z J Obstet Gynaecol. 2011; 51: 360-364
        • Creatore M.I.
        • Moineddin R.
        • Booth G.
        • et al.
        Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada.
        CMAJ. 2010; 182: 781-789
        • Diabetes Canada
        Food and nutrition tools for South Asian populations.
        (Accessed June 13, 2017)
      1. Khalil N. Heart and stroke screening clinic invites South Asians to healthy lifestyle. Brampton Guardian. https://www.bramptonguardian.com/news-story/6004922-heart-stroke-screening-clinic-invites-south-asians-to-healthy-lifestyle. Published March 20, 2014. Accessed February 23, 2019.

      2. Heart and Stroke Foundation. Healthy eating for South Asians. https://www.heartandstroke.ca/-/media/pdf-files/canada/south-asian-resources/366_southasianheathyeating_single.ashx. Accessed July 11, 2017.

        • Vyas A.N.
        • Chaudhary N.
        • Ramiah K.
        • Landry M.
        Addressing a growing community’s health needs: Project SAHNA (South Asian Health Needs Assessment).
        J Immigr Minor Health. 2013; 15: 577-583
        • Kemper D.W.
        Trust on the health Internet.
        Manag Care Q. 2001; 9: 9-18
        • Kalichman S.C.
        • Benotsch E.G.
        • Weinhardt L.
        • Austin J.
        • Luke W.
        • Cherry C.
        Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: Preliminary results from a community survey.
        Health Psychol. 2003; 22: 111
        • Bradley H.
        Gender.
        Polity Press, Cambridge2007
        • Roy S.C.
        ‘Taking charge of your health’: Discourses of responsibility in English---Canadian women's magazines.
        Sociol Health Illness. 2008; 30: 463-477
        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough? An experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Shah B.R.
        • Chiu M.
        • Amin S.
        • Ramani M.
        • Sadry S.
        • Tu J.V.
        Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: A validation study.
        BMC Med Res Method. 2010; 10: 42
        • Bunniss S.
        • Kelly D.R.
        Research paradigms in medical education research.
        Med Educ. 2010; 44: 358-366
        • Glaser B.
        • Strauss A.
        The discovery of grounded theory.
        Weidenfield & Nicolson, London1967
        • Green J.T.N.
        Qualitative methods for health research.
        3rd edn. Sage, Los Angeles2013
        • Erickson R.J.
        Why emotion work matters: Sex, gender, and the division of household labor.
        J Marriage Fam. 2005; 67: 337-351
        • Coltrane S.
        • Shih K.Y.
        Gender and the division of labor. Handbook of gender research in psychology.
        Springer, New York2010 (pg. 401–22)
        • Kaptein S.
        • Evans M.
        • McTavish S.
        • et al.
        The subjective impact of a diagnosis of gestational diabetes among ethnically diverse pregnant women: A qualitative study.
        Can J Diabetes. 2015; 39: 117-122
        • Diabetes Canada
        Multicultural resources..
        2019 (Accessed February 23, 2019)
        • Anand S.S.
        • Gupta M.
        • Teo K.K.
        • et al.
        Causes and consequences of gestational diabetes in South Asians living in Canada: Results from a prospective cohort study.
        CMAJ Open. 2017; 5: E604
        • Chiu M.
        • Austin P.C.
        • Manuel D.G.
        • Shah B.R.
        • Tu J.V.
        Deriving ethnic-specific BMI cutoff points for assessing diabetes risk.
        Diabetes Care. 2011; 34: 1741-1748
        • Ogilvie L.D.
        • Burgess-Pinto E.
        • Caufield C.
        Challenges and approaches to newcomer health research.
        J Transcult Nurs. 2008; 19: 64-73