Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives

Abstract

Objective To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community. Design Qualitative study (focus groups and semistructured interviews). Setting Tower Hamlets, a socioeconomically deprived London borough, United Kingdom. Participants Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3). Methods 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis. Results Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding.

What are the barriers to primary prevention of type 2 diabetes in black and minority ethnic groups in the UK? A qualitative evidence synthesis

“…There were particular gaps in understanding reported in relation to religious beliefs, male-female dynamics in Islamic culture and perceived body image in the way they impact on health and health promoting activities. For example, South Asian Muslim women commented on a non-Muslim perception that the practice of Islam and physical activity are incongruent (Carroll et al 2002), a belief that was refuted by both lay members of the community and religious leaders (Grace et al 2008). …”

“…Some South Asian men also found attendance at mixed gender sessions uncomfortable (Farooqi et al 2000;Grace et al 2008). There was a reported dislike of the gym environment by first generation Muslim women (Khanam & Costerelli 2008; Rai & Finch 1997); in particular, the use of loud 9 music, inappropriate television scenes and the need to dress in a culturally inappropriate way were cited as deterrents. …”

“…However, some South Asian women are beginning to cook traditional meals in more healthy ways, such as reducing the amount of fat (Netto et al 2007). Women from Zimbabwe were not used to cooking for themselves as in Africa maids had done the cooking; having to cook in the UK was seen as time consuming (Lawrence et al 2007).Just as dietary behaviours were reported as having different associations and practices in the homeland compared with the UK, physical activity also had a different purpose and association 'back home', where every-day activity such as housework or river bathing was the norm and vigorous exercise was seen as unnecessary, or unacceptable (Darr et al 2008; Rai & Finch 1997;Grace et al 2008;Farooqi et al 2000; Khanam & Costarelli 2008;Carroll et al 2002).Swimming and slow walking were preferred ways to remain active (Rai & Finch 1997; Khanam & Costarelli 2008). In the UK, organised activities such as attendance at swimming or dance classes or membership of a gym are the typical method of exercise (Khanam & Costarelli 2008; Rai & Finch 1997; Kopp 2009;Carroll et al 2002).…”

“…First generation migrants in particular were more likely to use traditional foods for cooking which were not always available locally and were reported to be expensive (Grace et al 2008; Lawrence et al 2007;McEwen et al 2008). Yet 12 travelling to shops, or indeed to physical activity classes, created problems in respect of navigating the public transport system with a limited use of the English language.There were also fears regarding safety when travelling out of the neighbourhood (Grace et al 2008).Five included studies reported body image issues as potential barriers or facilitators to healthy lifestyle behaviours. Differences were reported between expectations and associations of body image in the UK and in other cultures (Darr et al 2008;Grace et al 2008; Lawrence et al 2007; Khanam & Costarelli 2008; Netto et al 2007).…”

Lifestyle interventions in preventing new type 2 diabetes in Asian populations

“…Many minority patients have difficulty communicating with their health-care providers and other cultural barriers may exist [71]. A qualitative study performed in the UK identifies a main barrier for the Bangladeshi community in the complex value hierarchy of what is accepted to be healthy (small portion size, limited rich and fatty food, regular activity) and what is important for the social norms of hospitality, the religious requirement for modesty, and the cultural rejection of a ''sporting'' identity or dress (especially for women, older people, and senior members of the society) [72]. Contemporary health promotion, usually based on assumptions of a self-investment, should thus leave the approach to individuals when the aim is to involve societies with a collectivist history [73].…”