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

Case Study 2: Culturally Responsive and Family Support Project for Diabetes Prevention and Management: Involving a Community Health Broker to Support Families in Holistic Care

Lead Organization

• Multicultural Health Brokers Co-operative

Key Partners

• (Former) Capital Health Region, Regional Diabetes Program (now Alberta Health Services)

Funder

• Public Health Agency of Canada

Target Group

• Families from the following communities: Chinese, Vietnamese, Spanish-speaking, Korean, Filipino, South Asian, former Yugoslavia, Eritrea and Ethiopia.

Communities

• Edmonton, Alberta

Background

A growing body of evidence suggests that people of South Asian, Asian, Latin American and African origin have an increased risk of developing type 2 diabetes compared with the general population. Edmonton has the sixth-largest share of Canada's settled immigrants, according to the 2006 Census. Most of the newcomers to Edmonton were born in Asia and the Middle East, including the Philippines, India, and the People's Republic of China. Culturally and linguistically appropriate care is crucial to diabetes prevention and management for immigrant communities. The Multicultural Health Brokers Co-operative employs "multicultural health brokers" (MHBs) who are part of the target communities in order to provide linguistic interpretation; help individuals access services and resources; and support community development. MHBs provide support in the full range of continuum of care: health promotion, the social determinants of health, and chronic disease management. Their practice is holistic, and they use a family approach.

"Plan it with them [community members] or at least talk to some of them. There's value in being able to connect with them, even though there is not a lot of time during proposal development."

Project Coordinator

Implementation

Screening

• Participants included individuals and their family members who had previously used the MHB's services and met the following criteria: have either diabetes or pre-diabetes; are overweight or obese; are over the age of 40; have high blood pressure and/or cholesterol; have a family history of diabetes; have given birth to a baby weighing more than nine pounds.
• Information was collected on family history, nutrition and physical activity habits, breastfeeding history and birth weight.

Intervention

• One-on-One Education and Support - The MHBs worked with individuals and family members to carry out culturally appropriate management plans. For example, MHBs worked with family members to plan and prepare healthy ethnic meals.
• Small Group Activities - The MHBs planned and organized group activities with community participants, such as group classes on diabetes management for immigrant seniors and gestational diabetes prevention and management for pregnant women and new mothers.
• Seed Funding - Small amounts of funding were set aside for communities to plan their own activities (e.g. hiring a tai chi instructor, asking a dietitian to help prepare healthy lunches). At the end of the program, a large fair was held to give the communities an opportunity to showcase the projects they undertook.

Evaluation

The evaluation approach consisted of a combination of qualitative methods carried out upon project completion. These included interviews and surveys with clients and MHBs, and document reviews were conducted.

Results

Highlights of the evaluation results include the following:

• The MHBs exceeded their participation estimates in both home visits and group activities for this program.
• Clients perceived MHBs as a leading source of credible, culturally and linguistically accessible information.
• Clients indicated that a key element of family support was the emotional support provided by MHBs to clients and their families.
• A knowledge survey indicated that the MHBs were quite knowledgeable about general diabetes and healthy eating but less so about information related to physical activity.

Reaching the Population

MHBs are members of the communities of interest, and provide culturally and linguistically sensitive care for immigrants and refugees. In their work, the MHBs strived to develop a shared understanding of clients' issues and concerns rooted in core health promotion values.

"A lot of immigrants prefer in-home support—whether it's prevention, education or management. It's best to see the home-measuring cups are different across cultures!"

Project Coordinator

Lessons Learned

• There were some challenges around sustaining partnerships with the local regional health authority. For future projects, more time will be taken to understand organizational structures of partnering organizations, and engaging leaders within the programs who share the same philosophical commitment to health promotion principles as the Multicultural Health Brokers Co-operative.
• The lasting component of the program is the training and experience that the MHBs have gained working with families, older adults and children.
• Some of the activities initiated by this project have been integrated into regular programming; information about gestational diabetes has been incorporated into multilingual prenatal classes in nine communities.
• A partnership was developed with the City of Edmonton Community Services to increase the number of immigrant seniors participating in the City's recreation programs and events.

Resources

The following resources were developed in various languages:

• Diabetes fact sheets (in three languages); and
• Diabetes bingo (multilingual).

For additional information:
Lucenia Ortiz E-mail: lucenia@shaw.ca