RESUMEN
BACKGROUND: South Asian people living in Canada face higher rates of gestational diabetes mellitus (GDM) compared to national trends. The objective of this study was to design and pilot test a knowledge translation (KT) tool to support GDM prevention counselling in primary care. METHODS: This study is a mixed-methods pilot evaluation of the "SMART START" KT tool involving 2 family physicians in separate practices and 20 pregnant South Asians in Ontario, Canada. We conducted the quantitative and qualitative components in parallel, developing a joint display to illustrate the converging and diverging elements. RESULTS: Between January and July 2020, 20 South Asian pregnant people were enrolled in this study. A high level of acceptability was received from patients and practitioners for timing, content, format, language, and interest in the interventions delivered. Quantitative findings revealed gaps in patient knowledge and behaviour in the following areas: GDM risk factors, the impact of GDM on the unborn baby, weight gain recommendations, diet, physical activity practices, and tracking of weight gain. From the qualitative component, we found that physicians valued and were keen to engage in GDM prevention counselling. Patients also expressed personal perceptions of healthy active living during pregnancy, experiences, and preferences with gathering and searching for information, and key preventative behaviours. CONCLUSIONS: Building on this knowledge can contribute to the design and implementation of other research opportunities or test new hypotheses as they relate to GDM prevention among South Asian communities.
Asunto(s)
Diabetes Gestacional , Embarazo , Femenino , Humanos , Diabetes Gestacional/prevención & control , Proyectos Piloto , Ciencia Traslacional Biomédica , Aumento de Peso , Atención Primaria de Salud , OntarioRESUMEN
OBJECTIVES: The higher prevalence of diabetes in the South Asian (SA) population living in Canada spans across generations and is often associated with individual risk factors while undermining the social determinants of health (SDOH). There is a scarcity of studies on the perspectives of SA adolescents with a family history of type 2 diabetes mellitus (T2DM). Learning directly from these adolescents can fill a major gap by providing insight on how the SDOH contribute to disproportionate rates of T2DM in SA immigrant communities. METHODS: In this study, we used Photovoice, which is a community-based participatory research (CBPR) method that involves the use of photography to visually capture the challenges of diabetes prevention from the perspective of those with lived experiences. A group of 15 SA youth were recruited from an adolescent diabetes education program in the Peel Region of Ontario. The youth discussed their images and accompanied written narratives during focus groups. RESULTS: Four themes emerged from the thematic analysis of the photographs and participant narratives that influence the manifestation of T2DM in SA communities: 1) immigration and resettlement stressors; 2) food insecurity; 3) unhealthy school environments; and 4) academic pressures. CONCLUSIONS: Findings suggest the need to address T2DM as a response to unjust conditions and environments rather than as an epidemic entrenched in genetic predisposition, culture, and poor lifestyle choices.
Asunto(s)
Diabetes Mellitus Tipo 2 , Humanos , Adolescente , Ontario/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Determinantes Sociales de la Salud , Educación en Salud , Grupos FocalesRESUMEN
South Asian (SA) Americans have a high risk of metabolic and cardiovascular disease. Prevention efforts should start in childhood and should be culturally appropriate. We sought to understand the challenges and barriers that pediatricians face in providing care for SA children to inform professional education on culturally effective care. Qualitative interviews were conducted with a diverse sample (N = 17) of pediatricians. Challenges reported included feeding problems, inadequate physical activity, and mental health concerns. Communication barriers included parents' anxiety around feeding, influence of grandparents, stigma around mental health, and cultural communication gaps. Effective strategies included clear communication, a gradual approach, ensuring buy-in from grandparents, greater attention to family history, and improved cultural knowledge in pediatrician. Addressing feeding problems was the most mentioned challenge, which is especially concerning given the high chronic disease risk in SAs. Education on culturally appropriate strategies can equip pediatricians to effectively counsel SA families to address these risks.
Asunto(s)
Pueblo Asiatico , Barreras de Comunicación , Atención Primaria de Salud , Niño , Humanos , PediatrasRESUMEN
Asian Indians are at increased risk of developing cardiometabolic diseases. We sought to determine differences between Asian Indians and other races/ethnicities in hypertension and diabetes prevalence and associated annual blood pressure (BP) and fasting blood glucose (FBG) testing. A total of 257,652 adults ≥18 years from the 2011-2018 U.S. National Health Interview Surveys (NHIS) were included. BP and FBG testing in the past 12 months was defined dichotomously (yes/not yes). Racial/ethnic groups included non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian Indian, Other Asians, and Hispanic/Multiracial. We used logistic regression, adjusting for covariates and the survey design. Analyses were completed from 08/2020-06/2021. Asian Indians (N = 3049) had 21% and 99% higher odds of hypertension and diabetes, respectively, than NHWs (aOR [95% CI]; hypertension: 1.21[1.04,1.40], diabetes: 1.99[1.64,2.41]). Accordingly, Asian Indians without diabetes had significantly higher odds of FBG screening than NHWs (Asian Indian: 1.41[1.25,1.59], NHB: 0.99 [0.95,1.04], Other Asian: 1.07[0.98, 1.18], Hispanic: 1.13[1.07,1.20]). Asian Indians without hypertension had a 14% insignificant increase in BP testing compared to NHWs (1.14[0.97,1.33]). Predictors of testing in Asian Indians included older age, doctor's visit, graduate-level education, insurance coverage, and history of hypertension or diabetes. NHBs with diabetes and Hispanics with hypertension had lower odds of FBG testing (0.75[0.66,0.84]) and BP testing (0.85[0.79,0.92]), respectively, than NHWs. Asian Indians have higher odds of diabetes and hypertension than NHWs and higher, but relatively lower, odds of FBG and BP testing. Increasing routine BP and FBG testing in Asian Indians in younger adults may allow for earlier detection of high-risk individuals.
Asunto(s)
Diabetes Mellitus , Hipertensión , Adulto , Pueblo Asiatico , Estudios Transversales , Diabetes Mellitus/diagnóstico , Etnicidad , Humanos , Hipertensión/diagnósticoRESUMEN
The devastating effects of experiencing violence in childhood has been particularly difficult to assess among South Asians (SA) living in the U.S. due to a lack of race specific data. A cross-sectional quantitative study of 535 SA adult women living in the U.S. was conducted to better understand the relationship between childhood exposure to violence and health behaviors in adulthood. Measures included socio-demographics, exposure to violence as a child via witnessing parental violence, and experience of childhood violence, adult IPV, suicide ideation and attempt, and body esteem and subjective well-being in adulthood. Significant associations were found between childhood verbal abuse and body esteem and subjective well-being in adulthood; childhood physical abuse and subjective well-being in adulthood; and having a battered mother and subjective well-being in adulthood. To date, this is the first study to examine childhood violence and its relationship to adult IPV and health among SA women in the U.S.
Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños , Asiático , Violencia Doméstica , Estado de Salud , Violencia de Pareja , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
The devastating effects of experiencing violence in childhood are seen well into adulthood. This has been particularly difficult to assess among South Asians living in the U.S., due to a lack of disaggregated data on this ethnic group. In a web-based survey administered to a convenience sample of South Asian women living in the U.S. (n = 535), information was gathered on experience/exposure to childhood violence; adult intimate partner violence; and adverse health outcomes, including ever suicide ideation/attempt, experiences of quality of life and body esteem in adulthood. Further, an individual's acculturation levels were measured specifically looking at cultural identity which was guided by Berry's biculturalism model. This study found that acculturation status is a key factor with respect to childhood verbal, physical, and sexual abuse, as well as body esteem and an individual's well-being. These results suggest that acculturation plays a key role for childhood violence, as well as key adult health indicators. The findings in this study, suggest that more research is warranted to better understand the complex relationships between acculturation status and health. While studies of South Asian immigrants have increased substantially, the study on how acculturation influences family violence and health outcomes has lagged behind. The findings in this study will provide guidance for future work in understanding how acculturation can play a key role in addressing the health and well-being of South Asian women in the U.S.
Asunto(s)
Aculturación , Pueblo Asiatico , Violencia Doméstica , Mujeres/psicología , Adolescente , Adulto , Asia Occidental/etnología , Pueblo Asiatico/etnología , Pueblo Asiatico/psicología , Violencia Doméstica/etnología , Violencia Doméstica/psicología , Emigrantes e Inmigrantes , Femenino , Humanos , Persona de Mediana Edad , Autoimagen , Estados Unidos , Salud de la Mujer , Adulto JovenRESUMEN
Family violence, including child sexual abuse (CSA), is a significant public health problem in the United States. It is particularly difficult to assess family violence and CSA among South Asians because it is often hidden due to cultural and familial stigma. A web-based survey was administered to a convenience sample (n = 368) of South Asian adults in the US. One-fourth (25.2 %) of the sample reported CSA; 13.8 % reported abuse involving exposure; 21.5 % reported abuse involving touching; 4.5 % reported attempted sexual intercourse; and 3.5 % reported forced sexual intercourse. Adjusted odds ratios found that participants who reported any relationship violence were significantly more likely to have experienced CSA (OR 2.28; 95 % CI 1.26-4.13); and suicide attempt was significantly associated with CSA (OR 3.96; 95 % CI 1.27-12.3). The findings presented in this formative study will assist in guiding future studies and interventions for South Asians in the United States.