Barriers to Care for Cambodian Patients with Diabetes: Results from a Qualitative Study

Abstract

Racial and ethnic disparities in diabetes care have been well documented. While root causes have been explored for some minority groups, less is known about smaller immigrant populations such as Cambodians. In this study, we sought to explore the potential barriers to care for Cambodian patients with diabetes. We conducted five focus groups with three study groups: health care providers, bilingual Khmer frontline staff, and Cambodian patients with diabetes. Focus groups findings revealed that certain cultural beliefs, low health literacy, and language barriers strongly affect Cambodian patients' understanding of diabetes and self-management, as well as clinicians' ability to care effectively for Cambodian patients with diabetes. Our study supports previous literature and also adds several new insights not previously described. We recommend education for health care providers on patient-centered, cross-cultural care with an emphasis on the needs of Cambodians as well as culturally appropriate diabetes education for patients.

Socially Isolated Cambodians in the US

“…Social workers should advocate to legislators for a significant investment of resources to support CHWs, which would ensure that the right to access health care for some of the most vulnerable and marginalized Americans is realized, that the health care they receive is culturally appropriate, and that they receive preventive care services (Nguyen et al, 2008;Renfrew et al, 2013;Taylor et al, 2013). Employing CHWs would also ensure that health providers are in compliance with Title VI (Berthold & Fischman, 2014;Wagner et al, 2013).…”

Viewpoint: Using the patient-centred medicine clinical framework to better appreciate and explore the many barriers to care in Type 2 diabetes

“…This barrier was identified in 12 of the 28 articles. 12,13,16,20,21,[27][28][29][30]32,35,36 I. Disease and illness experience a) Fears/feelings as barriers to self-management i.…”

“…Fear or distress: The identified fear could be non-specific, such as fear of loss of control over their life, [14][15][16][17][18][19]37 or of potential future events (disease complications, 14,[22][23][24] and drug side effects 16,19,20,25,35,39 ). The fear could also be specific to events, such as glucose monitoring, 19,20,36 diagnosis, 18,21,22,24,29,37 starting oral medications, 16,18,19,36 starting insulin (including fear of insulin and needles), 16,[18][19][20][21]35,36,39 and fear of hypoglycaemia. 13,16,19 ii.…”

“…The process through which the patient and clinician reach mutual understanding and agreement in three key areas. specific beliefs, such as diabetes is caused by eating sugar, 15,19,23,36 a strict diet is required to control/cure diabetes, 18,19,36 only people with diabetes need to eat a healthy diet, 18,19,36,39 diabetes is like a 'cold' (it will just go away if ignored), 14,15,[17][18][19]23,27,29,35,36 diabetes is the same for everyone, 19,24 resignation to the diagnosis of diabetes, 15,23,24,29 symptoms as motivators (if there are no symptoms, then there is no need to take action), 15,18,19,21,23,29,32,33,35,36,39 diabetes is 'uncontrollable' (trouble coping), 15,20,31,34,39 they only need to take insulin if blood glucose is high, 35 and diabetes seen as a punishment. 15 ii.…”

Honouring the role of community in community health work with Cambodian Americans

“…Many studies have shown that Cambodian American CHWs decrease the fragmentation of healthcare, decrease overall healthcare costs and improve health outcomes across a diverse range of health conditions, such as cancer, diabetes and Hepatitis B (California Health Workforce Alliance, ; Nguyen, Tanjasiri, Kagawa‐Singer, Tran, & Foo, ; Renfrew et al, ; Taylor, Bastani, et al, ; Taylor, Burke, et al, ); however, their ability to build and strengthen their communities’ capacity remains understudied. Cambodian American CHWs’ understanding of their communities’ lived experiences and what is most needed at the community level are essential to ameliorating their communities’ health status.…”