Perspectives of UK Pakistani women on their behaviour change to prevent type 2 diabetes: qualitative study using the theory domain framework (original) (raw)
Related papers
Health Education Research, 2006
Type 2 diabetes is at least 4 times more common among British South Asians than in the general population. South Asians also have a higher risk of diabetic complications, a situation which has been linked to low levels of physical activity observed amongst this group. Little is known about the factors and considerations which prohibit and/or facilitate physical activity amongst South Asians. This qualitative study explored Pakistani (n 5 23) and Indian (n 5 9) patients’ perceptions and experiences of undertaking physical activity as part of their diabetes care. Although respondents reported an awareness of the need to undertake physical activity, few had put this lifestyle advice into practice. For many, practical considerations, such as lack of time, were interwoven with cultural norms and social expectations. Whilst respondents reported health problems which could make physical activity difficult, these were reinforced by their perceptions and understandings of their diabetes, and its impact upon their future health. Education may play a role in physical activity promotion; however, health promoters may need to work with, rather than against, cultural norms and individual perceptions. We recommend a realistic and culturally sensitive approach, which identifies and capitalizes on the kinds of activities patients already do in their everyday lives.
Perceptions of a Culturally Tailored Adapted Program to Prevent Type 2 Diabetes
International Journal of Diabetes and Clinical Research, 2015
Objective: To explore African and Caribbean immigrants' perceptions of a culturally tailored intervention to prevent type 2 diabetes. Methods: Using a purposive sampling scheme, 29 participants (26 women and 3 men, mean age 48 years and average length of residency of 22 years in Canada) participated in this study. The researchers used in-depth focus groups and individual surveys to collect qualitative data from participants. Following these interviews, participants individually reviewed the intervention and provided written feedback on their perceptions of the intervention. Data were analyzed using thematic analysis. Findings: Three themes emerged from the data: motivating factors to engage in physical activity and healthy eating, barriers that prohibit engaging in physical activity and increasing knowledge about food selection and modification of diet. In addition to the themes, participants had positive perceptions of the intervention. Eighty six percent rated the intervention as very useful and 83% were very satisfied with its contents. They reported that the intervention was culturally consistent with their beliefs, values and cultural practices in preventing type 2 diabetes. Conclusion: Perceptions of this culturally tailored intervention provided valuable evidence to assist the researchers in moving forward to the next level of research development such as evaluating the effectiveness of the intervention on the targeted groups' outcomes: self-care knowledge, performance of physical activity, healthy eating practices and self-efficacy.
BMC Public Health, 2019
Background: UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COMB framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. Methods: An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COMB framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. Results: Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques.
Ethnicity & Health, 2008
Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts. Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones. Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be ‘dangerous’ and detrimental to their diabetes control. Respondents described such foods as ‘strength-giving’, and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines. Conclusions. Perceptions that South Asian foodstuffs necessarily comprise ‘risky’ options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed. Keywords: food; diet; identity; type 2 diabetes; Pakistani; Indian
British-Pakistani women's perspectives of diabetes self-management: the role of identity
Journal of clinical nursing, 2015
To explore the effects of type 2 diabetes on British-Pakistani women's identity and its relationship with self-management. Type 2 diabetes is more prevalent and has worse outcomes among some ethnic minority groups. This may be due to poorer self-management and an inadequate match of health services to patient needs. The influence that type 2 diabetes has on British-Pakistani women's identity and subsequent self-management has received limited attention. An explorative qualitative study. Face-to-face semi-structured English and Urdu language interviews were conducted with a purposively selected heterogeneous sample of 15 British-Pakistani women with type 2 diabetes. Transcripts were analysed thematically. Four themes emerged: Perceived change in self emphasised how British-Pakistani women underwent a conscious adaptation of identity following diagnosis; Familiarity with ill health reflected women's adjustment to their changed identity over time; Diagnosis improves social ...
Canadian Journal of Diabetes
South Asians are the largest visible ethnic minority group in Canada and are at high risk of developing type 2 diabetes (T2DM). This research project aims to understand how diabetes self-management education (DSME) and support (DSMS) is delivered to South Asians with T2DM and how these practices are culturally tailored. The scientific literature was searched using electronic databases to find 1259 research studies, of which four examined the effectiveness of DSME/DSMS provided to migrant South Asians with T2DM. Only one study showed significant improvements in blood glucose control. All of the four studies contained several DSME/DSMS components and they all failed to address differences in gender roles and responsibilities in relation to South Asian culture. Thus, there is a need for future studies to design DSME/DSMS interventions that are culturally tailored to improve blood glucose control and thus, improve the health and well-being of South Asians with T2DM.
Journal of Social Health and Diabetes, 2017
Diabetes mellitus (DM) afflicts an estimated 65 million people in India which is project to exceed 109 million by 2035. [1] Poor metabolic control in DM patients increases their risk of the development of several microvascular and macrovascular complications which affect organs such as eyes, heart, kidneys, pancreas, and nerves [2] and decrease their quality of life, increase health-care costs, Patient adherence to recommended diabetes self-care practices reduces the risk of diabetic complications. However, most clinic-based approaches have proved inadequate in maintaining optimal diabetic self-management and the prevention of undesirable health outcomes at the population level among disadvantaged populations. Several sociocultural factors influence patient adherence to diabetic self-care practices which should be recognized and addressed by the health-care provider, especially in lower socioeconomic status and women patients. The lack of physician empathy and tendency to assign blame upon diabetic patients for the failure of adherence without recognizing the complex sociocultural factors influencing patient behavior can undermine the possibilities for better management. The enlistment of familial support when available is valuable for improving medical adherence and health outcomes in vulnerable diabetic patients with low health literacy. Young unmarried women with diabetes are particularly at risk of diabetes stigma eroding familial support and marital prospects require need effective health communication along with their family. Moreover, women with diabetes have a greater likelihood of compromising their dietary needs for the sake of their familial dietary preferences. The inability of patients to comply with recommended exercise regimen may be derived from environmental factors; primarily unsafe neighborhoods, lack of availability of nearby recreational facilities such as public parks, and cultural resistance in patriarchal social environments. Policy approaches for improving diabetes management in disadvantaged diabetic populations should consider mandatory registration, assured diabetic medication, and follow-up in case of missed appointments. Community mobilization for overcoming societal stigma against women with diabetes also persists as a formidable challenge.
Ethnicity & Health, 2021
Objective: The purpose of this study was to examine cultural beliefs, attitudes, and practices of Black sub-Saharan Africans (BsSAs) in the UK regarding their type 2 diabetes (T2D) self-management using the concepts of the PEN-3 cultural model. Method: A qualitative study involved 36 semi-structured interviews with BsSAs living with T2D in the UK to examine relevant cultural practices and beliefs that have contributed to the uneven burden of self-management behaviours. A narrative thematic analysis of the data was then conducted for the study using NVivo software and guided by the PEN-3 cultural model, which moves beyond individualistic health behaviour models of diabetes but centralises culture in understanding health behaviours. Results: Cultural perceptions and self-management behaviours of T2D varied among the BsSAs. Systems of self-management and treatment practices that were congruent with their cultural beliefs and personal priorities were seen as essential in the positive response to self-managing T2D. Knowledge and perceptions of non-conventional and alternative remedies linked to cultural beliefs reflected the existential health-seeking behaviours, and the significance attached to BsSAs negotiated cultural identities and collective practices within the communities. Social network supports were seen as enablers while advice and regimens from healthcare professionals (HCPs) were presented as medicalised and devoid of cultural sensitivities to respondents. Conclusion: The study findings highlight the need to be not only aware of the negative impact of diabetes perceptions and health behaviours among the BsSA communities, but also be aware of the 3 enabling factors and collective practices within the communities that are equally critical in influencing the self-management and health-seeking decisions of BsSAs living with T2D. PEN-3 model was significant with exploring not only how cultural context shapes health beliefs and practices, but also how social networks and systems play a critical role in enabling or nurturing positive health behaviours and health outcomes.
Scandinavian Journal of Public Health, 2010
Aims: To explore barriers to healthy dietary changes experienced by Pakistani immigrant women participating in a culturally adapted intervention, and whether these barriers were associated with intentions to change dietary behaviours. Methods: Participants were randomly assigned to control and intervention group. The 7-month intervention consisted of six educational group sessions on diet and physical activity, based on knowledge about Pakistani lifestyle and focusing on blood glucose control. Data on barriers for and intentions to healthy dietary changes were collected through an interview with help of a questionnaire. The article is based on data from follow-up assessments in the intervention group, comprising 82 women, aged 28-62 years, without a history of type 2 diabetes. Results: The most important barriers to healthy dietary changes were preferences of children and other family members and perceived expectations during social gatherings. The perceived pressure from other family members was especially strong when the women were trying to change to more vegetables, lentils, and fish and to use less oil in food preparation. The barriers were inversely related to intentions to change. Conclusions: The women encountered various types of barriers when trying to change to healthier food habits, the most prominent being those related to the social dimensions of food consumption, as well as to awareness of the amount of oil used for cooking.