The impact and management of diabetes among the Lebanese community in Sydney

Abstract

Although the prevalence of diabetes among Middle Eastern people is unusually high, little is known about the prevalence and management of diabetes among Lebanese immigrants in Australia. This study explored the experience of diabetes in the Lebanese community of Sydney, one of the city’s fastest growing ethnic groups. It examined the factors that contribute to the management and self-care of diabetes and the impact of the disease on daily life, work and relationships. The participants were Lebanese men and women aged 40-55 years who lived in the Sydney metropolitan area and who had been diagnosed with diabetes for at least six months. Both convenient and snowball sampling techniques were used to recruit eligible participants from medical practices that mainly served the Lebanese community. This study employed a mixed methods design. Qualitative data were collected via 25 in-depth interviews, which focused on the management and impact of diabetes. A survey (N>200) collected quantitative data on the socio-demographic characteristics of participants, health status, diagnosis and treatment of diabetes, lifestyle, self–care, quality of life, management of the disease and emotional wellbeing. Management of diabetes was measured using the Patient Activation Measurement (PAM) scale and quality of life (QOL) was measured with the CES-D scale. The mean age of all participants was 48 years and the majority in both studies had been diagnosed with diabetes between the ages of 41 and 50 years. Analysis of the qualitative data showed that lack of communication and education due to language and cultural barriers created a difficult environment in which to treat diabetes among this minority group. Health professionals did not take enough time to explain the causes and effects of the disease to their patients and failed to understand the social and dietary customs of the community. The majority (78%) of the survey participants were male and married (94%). Only about one-third had formal education and less than half were employed at the time of the study. More than one-third reported impaired mobility, around half struggled with personal care and hygiene, and 74% experienced difficulties at work. Diabetes incapacitated 80% of those attempting to do household chores, more than 75% experienced pain and discomfort and 73.5% suffered bouts of anxiety and depression. The t-test results indicated that males were more likely to follow a medical plan than their female counterparts, while ANOVA showed that the middle-aged participants were significantly more confident than the young and older cohorts at following their medication plans. Both results were significant at p=<0.05. ANOVA results also showed that participants with no formal education were less confident in preventing and reducing further complications of the disease than their educated counterparts. Both gender and diabetes education were significantly associated with stress, however there was no statistically significant association between diabetes self-care and demographic factors such as age, gender, language and diabetes knowledge. The results suggest that diabetes affected both the physical and emotional health of participants and that individuals with diabetes may experience considerable anxiety and stress as they attempt to manage their disease. A key finding was that education programs need to be tailored to meet the specific needs of women, as well as those of younger and older cohorts, if they are to be effective in improving understanding and management of diabetes and enhancing quality of life. Further, the qualitative results also showed that a number of participants perceived health professionals are lacking understanding of cultural practices and ethnic foods when they were recommending diets and management planning of diabetes, which suggest there is a need for professionals’ cultural competency training. Overall, the findings fill a gap in existing knowledge and have important implications for professional practice with this vulnerable group. No claim is made that the descriptive findings of this study can be generalised to other ethnic groups. The thesis concludes with recommendations for further research on a larger and more heterogeneous population so that multivariate analysis could be used to identify confounding factors. Case-control studies would be able to investigate the temporal relationship between exposure and outcome, and other more objective variables, such as hemoglobin A1c, should be examined to provide a more accurate assessment of the quality of diabetes care.