Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for
Ilene Hyman1, Yogendra Shakya2, Nathaniel Jembere3
1Consultant in Research and Evaluation and Adjunct Professor at the Dalla Lana School of Public Health at the University of Toronto in Ontario. i.hyman@utoronto.ca.
Objective:
To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants.
Design:
Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu.
Setting:
Toronto, Ont.
Participants:
A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less.
Main Outcome Measures:
Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care).
Results:
A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses (P = .0233), and the quality of the provider-patient relationship (P = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices.
Conclusion:
Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management.
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