Racial and ethnic minorities
- Access to health care and other resources for diabetes. Minority groups tend to have less access to health care services, educational interventions and prevention interventions or are unaware of services that may be available to them in their communities (Schraer, 2001). Limited access may also be a result of financial barriers.
- Language. The inability to speak, read or understand English well can hinder one’s ability to communicate with or understand his/her primary care provider. Often bilingual clinical staffs are not available to provide individuals with the health and self-care information they need. Interventions will likely be ineffective if participants do not understand the materials or information being provided (Thomas, 2002).
- Literacy. Most available diabetes education materials are either written at a high reading level (Schillinger, 2002).
- Cultural norms and beliefs in relation to health behaviors. Food preferences and preparation methods may be strongly identified with traditions. Eating patterns in combination with other cultural lifestyle factors can contribute to increased risk of diabetes (Anderson-Loftin, 2005). In terms of health-seeking behaviors, it is important to recognize that some racial and ethnic minority groups may not seek preventive or primary care. These groups may have a high level of anxiety and instead prefer to only seek care in the case of an emergency (Kirk, 2005). A lack of primary and consistent care may lead to negative diabetes-related health outcomes (Carter, 1996).
- Cultural attitudes in relation to body image. Racial and ethnic minority groups have differing ideals of body shape and size. Some may view a larger body size as culturally more desirable or acceptable (Thomas, 2002). These beliefs and norms may lead to different perceptions about the importance or impact of making healthy food and physical activity choices that could lead to a more protective body shape or size.
- Stress. Stress related to family responsibility and work can make it hard to find time for physical activity or the resources to purchase and prepare healthy foods. As a result, diabetes may be ranked as a low priority and therefore, less of a concern for changing behavior. This can increase the risk for diabetes and reduce the likelihood of seeking care for the disease (Simmons, 1996).
- Susceptibility. Many racial and ethnic minority groups, especially those who also have a low income, have a higher susceptibility to developing diabetes. Such health disparities may be attributed to multiple influences of genetics, lifestyle and other environmental factors that promote obesity and make weight loss difficult (Carter, 1996).
Strategies to address racial/ethnic minority population considerations
- Improve access to health care and other resources for diabetes. It may be useful to work with community partners to enhance existing resources or to build new resources (Schraer, 2001). It may be worthwhile to work with health care organizations, pharmacies, recreational facilities, and grocery stores to identify the most appropriate strategies for your community. Some examples include initiating sliding scale fees for services, discounts and coupons.
- Address barriers related to language.Diabetes education information should be delivered in a simple and clear manner and include appealing visual teaching tools. This may mean creating materials that are in the community’s first language, using common terms in place of medical terms, and using visual images that represent the individuals in the community and their experiences. Providing translators can also help to ensure that information is received and understood (National Center for Cultural Competence, 2009).
- Tailor to culture. Interventions should be culturally appropriate, taking into account the familial, faith and community influences on behavior and the desire to fit within cultural norms. You might consider incorporating family into physical activity and nutrition interventions rather than just individuals, or consider holding interventions at worksites, schools, faith-based organizations where individuals spend a great deal of their time (Simmons, 1996). It may also be useful to address barriers related to time, for example by encouraging ways of being active that include shorter, more frequent bouts of activity rather than longer time commitments. In addition, recognizing community priorities may lead to interventions that incorporate spiritual or other beliefs (Gohdes, 1996). Incorporating spirituality into intervention messages may help to recognize health beliefs that interconnect all aspects of mind, body, and soul. Treatments that focus on feeling good through proper diet and physical activity, as opposed to those that focus on treatment as a means for weight loss, may help to address differences in body image. It may also be important to acknowledge different health-seeking behaviors among different populations. When working with individuals with diabetes, this may mean addressing issues related to behavioral changes, implementing a self-management plan, or visiting a health care provider.
- Provide cultural competency training. Strategies to reach racial and ethnic minority populations should be culturally relevant (National Center for Cultural Competence, 2009). It may be useful to provide training in cultural competency to individuals who are working with a community so that they can learn more about the differences within and across communities and how these differences influence diabetes interventions. See Cultural Competence for more information.
- Develop self-management skills. In terms of education, there may be individual or group sessions to assist individuals with development and implementation of a self-management plan related to glucose management. Applied learning, such as cooking classes, is the most effective teaching method in these populations. Culturally-competent dietary self-management programs can prove effective in improving health outcomes associated with the risk for and progression of diabetes (Anderson-Loftin, 2005).
- Involve the priority populations. In order to attend to culture, it is important that individuals who are from the priority populations and are both bi-lingual and bi-cultural take an active role in planning, implementing and evaluating interventions. Designing interventions around social support [family, friends, co-workers, support groups and exercise buddies] to individuals with diabetes can be one of the strongest reinforcers for adapting a healthy lifestyle. To increase trustworthiness of racial and ethnic minorities, use persons to deliver diabetes messages who are from the same communities (Macaulay, 1997). Incorporating community participatory methods such as storytelling may help individuals to overcome their own diabetes care problems.
- Engage stakeholders. By engaging leaders and getting active participation by community members, you may be able to strengthen the credibility of and respect for the intervention. For example, by working with community members, pharmacies, health care personnel and schools, you may be able to gain support for the development of appropriate diabetes-related interventions that have the support of the structures needed for implementation (Satterfield, 2003). Recruit health care professionals of the same ethnic or racial background to deliver diabetes-intervention information. Recruit community or spiritual leaders to act as role models to encourage others to adopt positive lifestyle changes. Create a sense of intervention ownership and empowerment within a local population to improve the sociocultural climate by including local political and lay leaders and community health and welfare workers.
- Address participant needs. Consider providing childcare and transportation to increase participation (Bank-Wallace, 2002). Interventions that focus on small groups in racial and ethnic minority communities may be more effective than massive population-wide approaches. Participation of family members can capitalize on the value of family and provide transportation to those without access to transportation to intervention activities.
- Use established settings. Strategies should maximize participation in the intervention by having meetings or events at convenient locations and times (Bank-Wallace, 2002). It may be useful to link interventions with church or community social events. Look for the places people typically gather, and hold meetings and events in these places.
- Screening Programs. Strategies that encourage early detection or screenings might be beneficial, especially for racial/ethnic minorities, due to disproportionately high rates of diabetes and frequency of family history of the disease. It is also important to consider where messages relating to screening may be posted or shared. If community members are not going to medical care facilities until they are sick it may be useful to provide preventive messages in places where community members are likely to see and hear the message (e.g., popular radio stations, local markets, barber shops). Messages should be provided by role models the community respects (Jenum, 2006).
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