Reducing Health Disparities Related to Diabetes: Lessons Learned Through the Canadian Diabetes Strategy Community-Based Program

Case Study 1: A Culturally Sensitive Diabetes Prevention Program for Indo-Asian Women with a History of Gestational Diabetes - Tailoring a Program to a Diverse Population

Lead Organization

• (Former) Calgary Health Trust

Key Partners

• Community physicians' offices
• Diabetes in Pregnancy (DIP) Clinic
• (Former) Calgary Health region
• Indo-Asian Community

Funder

• Public Health Agency of Canada

Target Group

• Indo-Asian women with a history of gestational diabetes mellitus and their families

Communities

• Calgary, Alberta

Background

Approximately 5% of Calgary's population is Southeast Asian (based on 2006 Census figures). Some ethnic groups—Canadians of Southeast Asian, Hispanic and African origin—are three to four times more likely to develop diabetes than the general population. The incidence of gestational diabetes mellitus (GDM) is higher among Indo-Asian women than among women of European or American origin. It is estimated that approximately 50% of Indo-Asian women with GDM will develop type 2 diabetes within five years postpartum.

The goal of the Culturally Sensitive Diabetes Prevention Program was to develop an effective, community-based, culturally sensitive and sustainable postpartum diabetes prevention program for Indo-Asian women with a history of GDM.

Implementation

Program Recruitment

Referrals were made by the DIP clinic, community health services and physicians located in northeast Calgary (where a large proportion of Calgary's Indo-Asian population reside).

Program Development

The project team sought input from members of the target population on: perceived barriers to program awareness and participation and possible solutions, and perceived barriers to positive lifestyle changes and strategies to address these barriers.

Diabetes Prevention and Program Awareness

Culturally specific materials were developed and distributed, including posters, brochures, articles and television and radio segments in English and Punjabi. These materials were displayed in locations (e.g. temples, community pharmacies) and media (e.g. an Alberta cable channel, an Indo-Asian radio program) accessed by the target population.

Educational Intervention

Three Indo-Asian women with a history of gestational diabetes were recruited and trained as community workers to assist the program team.

Five two-hour educational classes were held with Indo-Asian women, followed up by a second meeting. The program was offered in Hindi, Punjabi and Urdu. Content focused on nutrition and exercise and was tailored to the participants' culture. For example,

• Modifying food preparation techniques;
• Altering culturally based meal habits that may hinder blood glucose regulation (e.g. suggested eating the first and last meals of the day earlier); and
• Providing recipes based on culturally relevant foods and food preparation methods.

Evaluation

Individual, community and system-level outcomes were measured and evaluated using project records, pre-post telephone surveys, program surveys, telephone interviews, and qualitative interviews. In addition, an assessment of the extent to which project outcomes continued to be sustainable after project funding ended was undertaken.

Results

Seventeen out of the twenty-three women who participated in the diabetes prevention educational program completed a pre- and post-education survey. Survey results revealed

• An increase in the perception of the seriousness of diabetes;
• An increase in the awareness of risk factors for diabetes;
• An increased perception of personal risk for diabetes; and
• That women were less likely to see lack of knowledge, time and social support as barriers to healthy eating and exercise.

After attending the educational program, women self-reported

• An increased compliance with oral glucose tolerance testing;
• Improvement in nutrition;* and
• An increase in exercise.*

(*Statistically significant P<0.05)

Reaching the Population

To serve the population,

• The program was offered in various Indo-Asian languages.
• The program was short in duration and flexible (to accommodate busy schedules).
• The program was offered at convenient times and often in participants' homes.
• Participants were given supplementary take-home written materials and videos.
• Transportation and childcare were made available, although these amenities were discontinued due to logistics and liability issues.

Lessons Learned

• The program has been modified to meet the needs of the population, by providing transportation and childcare, and offering classes close to where the women lived.
• Despite these modifications, some barriers remained; for instance, in some cultures, women do not leave the house for 40 days after giving birth.
• To accommodate these needs, home-based educational materials were developed, and the program is now offered on DVD and online
• Participants who are unable to attend classes in person are still assessed initially by a health care provider and have ongoing contact with them while they are completing the program
• Once the initial project ended, the program was adopted by the Calgary zone of Alberta Health Services
• A paper describing the project and its results has been submitted to a peer-reviewed journal.

"There were differences in the educational and acculturation levels of women attending programs—a challenge because you have to meet [everyone's] needs. Our staff took into consideration health literacy and educational levels, and other social determinants of health that impact participants' participation in the program. Having health professionals from the same cultural background who are familiar with community norms was very helpful."

Project Coordinator

Resources

Posters, brochures, articles and television and radio segments were developed in English and Punjabi.

For additional information: Bahigi Fyith, Program Lead
Diverse Populations, Alberta Health Services
E-mail: bahigi.fyith@albertahealthservices.ca

Shahnaz Davachi, Director,
Diverse Populations, Alberta Health Services
E-mail: shahnaz.davachi@albertahealthservices.ca