Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention

Abstract

To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic‐Speaking migrants in Denmark: A longitudinal qualitative analysis

“…Also, the fact that the HCPs were trained in cultural competence as well as dialogue and active listening with an emphasis on supporting individual change [11] may have increased the possibility of being more health literacy responsive, which is the core principle for mitigating the effects of challenged health literacy [14,37]. Our study showed that HCPs played an important role in enhancing HL levels among migrants.…”

“…This study invited participants from a culturally sensitive DSMES programme targeting migrant groups with Arabic, Turkish or Urdu as their first language and with no or limited Danish proficiency to partake in two interviews [11]. The purpose of the programme was to support health-promoting decisions and improve diabetes self-management, and covered subjects such as type 2 diabetes, insulin, diet, psychosocial issues, support, medicine, physical activity and comorbidities.…”

“…HCPs comprised dietitians, nurses and physiotherapists who were trained in promoting a flourishing mindset, cultural competence and active listening in an educational setting. This included a focus on recognising the target group's experiences, exchanging knowledge among the target group, and drawing attention to the target group's resources [11,28].…”

“…However, migrants tend to benefit less from participating in general DSMES programmes, which may not necessarily meet their needs and preferences [8,9]. While culturally sensitive DSMES programmes, incorporating cultural values, customs and beliefs, as well as the language preferences of migrants, have been shown to promote healthy behaviours, glycaemic control and well-being [10,11], little is known about how the learnings from these programmes are acquired, applied and distributed among migrants.…”

Dietary Knowledge and Eating Habits among Patients with Type 2 Diabetes in Lebanon

“…With this alarming increase, and in order to decrease complications and diabetes-related mortality, this health problem requires a comprehensive management plan where patients should be educated to make informed decisions about diet, exercise, weight, and medications, as recommended by the American Diabetes Association (ADA) [ 7 ]. In fact, patient education has been proven to improve knowledge, dietary behaviors, and health outcomes in patients with T2D, including HbA1c and mortality reductions, lower weight and body fat, and improved quality of life [ 8 ]. Also, knowledge of diabetes was found to be associated with compliance with treatment and a decrease in complications [ 9 ].…”