Towards improving diabetes care among Arabic-speaking background immigrant population: examining cultural and health beliefs

Type 2 Diabetes Mellitus (T2DM) is currently recognised as a major health issue. Individuals with T2DM are at higher risk of developing a number of microvascular, macrovascular and neuropathic complications. Globally, the prevalence of T2DM is increasing at epidemic rates and it is reaching alarming levels worldwide. Published data confirms that management of diabetes is more challenging among minority ethnic groups, compared to the general population, for several reasons: higher diabetes-related morbidity and mortality rates, worse glycaemic control, underutilisation of medical services, lower adherence rates, cultural and communication barriers. Understanding the relationship between patients’ cultural and health beliefs and diabetes self-care practices such as dietary behaviours, exercise, self-monitoring of blood glucose and medication-taking has been shown to provide an opportunity to inform development of culturally appropriate diabetes education. Drawing on substantial evidence documenting its effect on clinical outcome measures, the provision of culturally appropriate diabetes self-management education is widely acknowledged as an integral component of diabetes care among ethnic minority groups. Currently, there is a large body of research on cultural beliefs and diabetes experiences that have been conducted among ethnic minority groups such as Latinos/Hispanics, African Americans, Asians, Pacific Islanders and others. Anecdotally, it is known that ASB immigrants have a strong sense of cultural identity, adherence to their traditional and cultural norms and do not assimilate easily into western host society. There is, however, little research conducted among Arabic-speaking background (ASB) immigrants. Diabetes experiences from the perspective of ASB immigrants in Australia were needed to be explored to identify difficulties in performing self-management activities and to recognise modifiable health beliefs that are associated with non-adherence behaviours. This research, through the two stages reported herein, has investigated ASB immigrants’ views and beliefs about diabetes, identified issues in quality use of medicines, explored factors that influenced health care seeking behaviours, assessed diabetes learning needs and preferences, and measured the relationship between health beliefs, adherence and glycaemic control. Prior to this study, little was known about the diabetes profile, cultural and health beliefs and barriers to diabetes care among ASB immigrants in Australia. The results obtained highlighted poorer knowledge about diabetes and its management among ASB immigrants, compared to their English-speaking background (ESB) counterparts. Arabic-speaking background immigrants intentionally delayed accessing medical services when they experienced classical signs of diabetes, so diabetes complications were already developed at the time of diagnosis for the vast majority of them. Diabetes control of ASB immigrants was suboptimal and they were significantly less adherent to all aspects of diabetes self-care activities (dietary behaviours, exercise and physical activity, foot care, SMBG and medication-taking) than the ESB group. The negative health beliefs held by ASB immigrants were associated with non-adherence behaviours and with worse glycaemic control. This research has made a significant contribution to diabetes treatment adherence research in an ASB immigrant population. Findings of this research provide detailed information about the interplay between an individual’s cultural and health beliefs, adherence behaviour and glycaemic control. Such understanding, which has previously been lacking, may assist diabetes health professionals in planning culturally appropriate diabetes interventions and establishing best practice for this ethnic minority group