Responding to a diverse community with diverse diabetes education methods

One of the biggest challenges for health-care professionals is ensuring that patients understand what their diagnosis means and how they can best care for themselves. Constant testing and monitoring of blood sugar, learning about exercise and dietary changes can be a lot to learn, especially if you are receiving the information in a language that is not your mother tongue. To help its patients better understand the lifestyle changes required to manage their diabetes, York Central Hospital’s Diabetes Education Service has proactively adapted its services to accommodate the many different languages spoken by their clients.

“While most of our patients speak and understand English, a large number of our patients speak Italian and a growing percentage of our patients speak Cantonese, Mandarin, Urdu, Hindi or Punjabi as their first language,” says Andrew Lotto, Interim Coordinator of the Health and Wellness Centre. “Whenever possible, it makes sense to provide a person with the information they need to manage their illness in the language that they best understand.”

York Region is one of the fastest growing areas in the Greater Toronto Area. According to the 2006 census, 43 per cent of the York Region population is made up of immigrants. To meet the needs of its diverse community, the hospital is actively working with local community partners to offer diabetes education services to patients from a variety of cultural backgrounds, especially those cultural groups that are seeing growing rates of diabetes. Working with their community to identify current and future challenges enables the hospital to adapt its services to better meet the needs of these patients. “We’re very fortunate to have health-care professionals who speak many different languages and mirror the diversity of our community,” adds Lotto. “When the patient, as well as their family, understands what they need to know it makes managing their illness less stressful for all concerned.”

“We have many families with elderly parents who recently immigrated. They may have lived in the area for a while but have not needed to learn English,” says Julie Sartori, a Dietitian in the program who speaks Italian. “With a diagnosis of diabetes, many people find themselves in need of health-care services for the first time. It’s our job to ensure they understand what they need to do to help themselves on a day to day basis.”

“We have adapted much of our teaching to recognize that many of our patients may not fully understand the technical information we need to teach them if it is presented in English only,” adds Sartori. “Using non-verbal methods of communication such as pictures, diagrams and food models, we can help our patients better understand the nuances of managing their illness. We can show them recommended portion sizes versus just telling them. It makes all the difference to many of our patients.”

Registered Nurse Helen Poon speaks Cantonese and Mandarin and believes that patients who ask questions are patients who understand what they are being taught. “When a patient just smiles and nods there is a good chance that they do not fully understand what we are trying to teach them. Learning about insulin dosages, lifestyle changes or how to use a new insulin pump can be highly technical and overwhelming. Teaching them in their language encourages patients to ask questions and really learn the techniques they need to manage their illness.”

York Central Hospital’s Diabetes Education Centre is located away from the hospital, making patients comfortable from their first visit. “This friendly and inviting location is much less intimidating to someone than a hospital,” says Poon.

Helping patients learn to make real life decisions is a big part of proper diabetes management. The service offers trips to local grocery stores where health-care providers offer tips and advice on good food options for diabetic patients. For many, their traditional diet may need to be altered to accommodate new and unfamiliar foods. The Diabetes Education service also offers trips to local food courts and restaurants to show patients how they can still order off a menu and maintain their diabetes diet.

“The key to successful diabetes education is ensuring that all patients understand what they need to do in order to manage their illness,” says Lotto. “Whether this includes medication information, diet or lifestyle adjustments, and counseling, patients need to be shown that their illness can be managed. Speaking to patients in the language they best understand has helped us to make great strides in reaching out to patients who previously might not have had a true understanding of their illness.”