Development of a group-based diabetes education model for migrants with type 2 diabetes, living in Sweden

Abstract

Aim: To develop a diabetes education model based on individual beliefs, knowledge and risk awareness, aimed at migrants with type 2 diabetes, living in Sweden. Background: Type 2 diabetes is rapidly increasing globally, particularly affecting migrants living in developed countries. There is ongoing debate about what kind of teaching method gives the best result, but few studies have evaluated different methods for teaching migrants. Previous studies lack a theoretical base and do not proceed from the individuals’ own beliefs about health and illness, underpinned by their knowledge, guiding their health-related behaviour. Methods: A diabetes education model was developed to increase knowledge about diabetes and to influence self-care among migrants with type 2 diabetes. The model was based on literature review, on results from a previous study investigating knowledge about diabetes, on experience from studies of beliefs about health and illness, and on collaboration between researchers in diabetes care and migration and health and staff working in a multi-professional diabetes team. Findings: This is a culturally appropriate diabetes education model proceeding from individual beliefs about health and illness and knowledge, conducted in focus-group discussions in five sessions, led by a diabetes specialist nurse in collaboration with a multi-professional team, and completed within three months. The focus groups should include 4–5 persons and last for about 90 min, in the presence of an interpreter. A thematic interview guide should be used, with broad open-ended questions and descriptions of critical situations/health problems. Discussions of individual beliefs based on knowledge are encouraged. When needed, healthcare staff present at the session answer questions, add information and ensure that basic principles for diabetes care are covered. The diabetes education model is tailored to both individual and cultural aspects and can improve knowledge about type 2 diabetes, among migrants and thus increase self-care behaviour and improve health.

Beliefs about illness: comparing foreign- and native-born persons with type 2 diabetes living in Sweden in a cross-sectional survey

“…Foreign-born persons reported to a higher degree than Swedish-born that they had sought care due to diabetes mellitus during the last 6 months. The foreign-born persons in this study (Glans et al, 2008); (iii) they had a more information-seeking behaviour, previously found among persons from the Middle East (Hjelm et al, 2003(Hjelm et al, , 2005; (iv) they might have limited or lacking social networks to turn to for advice and that they come from cultures where people are more passive and rely on help from staff (Hjelm et al, 1999;Hjelm et al, 2003) and finally, (v) an indication of insufficient diabetes education, which may be neither individually nor culturally adapted (Hadziabdic et al, 2020). Diabetes care in Sweden is recommended and based on the national guidelines for diabetes care (Socialstyrelsen, 2018), which means that the majority of patients diagnosed with type 2 diabetes are managed in primary healthcare centres mostly by a general practitioner and a diabetes specialist nurse working in mini-teams.…”

Comparison of Beliefs about Health in Migrants and Swedish-Born Persons with Type 2 Diabetes

“…Whether the use of nature cure remedies influences health in persons with diabetes has been studied only to a limited extent. However, as individual beliefs are based on the person's knowledge and guide health-related behaviors, including self-care, it is important to assess them and to plan diabetes education based on individual beliefs about health [7].…”

“…The increasing prevalence of type 2 diabetes among migrants, persons who have moved to another country voluntarily as migrants or who have been compelled to move as refugees is well documented and leads to a grave public health task and a challenge for many European countries [5,6]. Language and cultural distance may influence health, self-care practices, education, and the type of healthcare required and provided [7], and make a significant impact on inequalities in diabetes care between persons of minority ethnic origin and the population of origin [5]. Health-related behavior, and thus health, is guided by individual beliefs about health and illness [8][9][10][11][12] that are culturally determined [13].…”

Direct, Indirect and Mixed Methods of Health Education By Nurse and Its Impact on Type 2 Diabetes Patients: A Literature review

“…Direct health education can be done through training programs (Martín-Payo et al ., 2021b); Baptista et al ., 2019), group discussions - Focus Groups Discussion/FGD (Hadziabdic et al ., 2020; Sousa et al ., 2019). Different forms of direct education given to patients is able to increase knowledge, self-care behavior (diet management, physical activity, monitoring blood sugar levels, lower limb/foot care) and self-empowerment.…”