Taking a cultural approach to diabetes education and care

More than 40,000 people living in Hamilton have diabetes. While many are on a diabetes care plan, many others don’t know how to deal with their disease or don’t even know that they have the disease. This is often due to a lack of information and to the traditions among many different cultures.

At Hamilton Health Sciences’ 2006 Cultural Advisory Summit on Diabetes Care and Culture, the participants (many of them representing diverse cultural groups) indicated that the cause and treatment of diabetes is poorly understood by some cultures. They stated that limited access to valid information, and language and literacy barriers contribute to misunderstandings about diabetes.

Since then, Hamilton Health Sciences’ Diabetes Care and Research Program, led by Clinical Manager Janet MacLeod, has done much to address these issues. The first step was to create the Hamilton Diabetes Collaborative with partner agencies across Hamilton. The main objective of this Collaborative is to improve access to diabetes education and management services.

Since the Collaborative launched in 2007, other agencies have joined and many initiatives have been implemented. For instance, the Collaborative developed a regional patient education strategy to improve access and coordination of patient education throughout Hamilton and ensure a self-referral process. It also developed a diabetes transfer record and discharge protocol to better inform primary care givers about the care and education their referred client has received.

“We’ve received a lot of positive feedback from the Ministry of Health and Long-Term Care and the Local Health Integration Network,” says Janet. “Although we’ve accomplished a fair amount since 2007, we have many more goals for the next few years. The Collaborative is doing exciting work and we’ve already seen the difference it’s making on diabetes care in Hamilton.”

A sub group of the Collaborative called the Coordination of Diabetes Education Working Group was also created. The members are currently completing Cultural Competency Training through the Hamilton Centre for Civic Inclusion, which will provide a common platform in moving their work forward in the redesign of culturally diverse and sensitive diabetes services.

A few people from the Hamilton Health Sciences Diabetes Care and Research Program have been integral in providing diabetes education to specific cultural groups. Dr. Ally Prebtani, Endocrinologist; Ashi Jain, Dietitian; and Andrea Miller, Primary Health Care Nurse Practitioner, target at-risk South Asian and African Caribbean groups by attending meetings at mosques and other community groups and tailoring diabetes education to focus on their specific lifestyles and foods.

Hameed Basaria, minister of the Ismaili Muslim Community Church was diagnosed with type 2 diabetes about eight years ago. Dr. Prebtani, a member of the church, has taken on Hameed as a patient and helps him keep his diabetes under control. He also put on a seminar about diabetes for the other members of the church to help them better understand the disease. “If even one person can benefit from the session then that’s a great reward,” says Hameed.

A new partnership has also just been formed with the De dwa da dehs nyes Aboriginal Health Centre and Southern Ontario Aboriginal Diabetes Initiative to determine a new model of diabetes education and management that is culturally sensitive to the needs of urban Aboriginal people. “They face significant barriers in accessing the traditional diabetes programs, which is very concerning given the staggering incidence of diabetes in this population,” explains Janet.

The Collaborative also offers regular free education sessions (some in different languages) to anyone in the Hamilton community interested in learning more about diabetes prevention, diabetes first steps, living well with diabetes, and soon, eating well with diabetes. They’ve also run health-care provider education sessions so providers can pass culturally-relevant diabetes information on to their patients.

“The Diabetes Collaborative promotes diabetes awareness in a sustainable way,” says Dr. Ally Prebtani. “When making a difference in health care you always have to think of the long-term impact, and the train-the-trainer concept does just that. It’s a domino effect.”