Assessing and Treating Diabetes in Diverse Populations. Shirley Pue+, LCSW, LCAS

Transcription

1 Assessing and Treating Diabetes in Diverse Populations Shirley Pue+, LCSW, LCAS

2 Objectives The purpose of this ac9vity is to enable the learner to: - List cultural barriers that make diagnosing and trea5ng diabetes in diverse popula5ons most difficult - Describe 3 unique ways that the American diet makes diverse cultures more suscep5ble to diabetes. - Compare and contrast how the na5ve diet of diverse cultures can lead to diabetes or actually prevent diabetes - List 3 tools a healthcare professional can use to overcome cultural barriers and more accurately diagnose and treat diabetes in pa5ents of diverse cultures. Describe how our healthcare system creates barriers to effec5vely trea5ng diverse popula5ons.

3 308.7 Million in US (2010)

4 NC Population by Ethnicity 2010 Hispanic- 800,120 Non- Hispanic ,363

5 NC Population by Race 2010 White 6,528,950 African American 2,048,628 Asian 208,962 American Indian and Alaska Na5ve 122,110 Na5ve Hawaiian and Pacific Islander 6,604 Other 414,030 Iden5fied by two or more 206,199

6 Communication Consider how challenging communica5on can be before factoring in a different language and/or culture 60% of informa5on that goes into a diagnosis results from the medical interview (HPI) Effec5ve communica5on is equally important in educa5ng our pa5ents and developing an acceptable treatment plan Without clear communica5on we cannot deliver the quality of care to which we are commiyed

7 Culture Defined by Leininger, culture refers to: learned, shared, and transmiyed values, beliefs, norms, and life ways to a specific individual or group that guide their thinking, decisions, ac5ons, and payerned ways of living

8 Culture Can be complicated to define Concept is ever changing within ethnic groups it ayempts to describe Encompasses day- to- day lives and ac5vi5es of people There are subcultures within cultures EVERY PATIENT deserves a cultural assessment

9 Common Barriers to Treatment Communica5on difficul5es between pa5ent and provider Cultural barriers Provider stereotyping Lack of access to health care Geography Inadequate health care coverage

10 Can Stereotyping Really InEluence the Clinical Encounter? Penner et al. (2010) concluded that white physicians implicit racial biases resulted in less posi5ve interac5ons with black pa5ents especially for MDs who displayed low explicit bias and high implicit bias Cooper et al. (2012) found that higher implicit race bias scores were associated with more verbal dominance and lower pa5ent posi5ve affect for black pa5ents

11 Situations that Promote Stereotyping Situa5ons of high uncertainty (filling in gaps of informa5on) Complicated tasks Time constraints Resource constraints Provider stress and exhaus5on Do you foresee any of these reasons contribu9ng to poor communica9on?

12 Communication Patterns Vary Verbal Topics such as sexuality and death may or may not be acceptable Forthright discussion may be considered rude Loud voice may mean anger or enthusiasm Finishing a conversa5on vs. being on 5me may be more valued Nonverbal Direct eye contact can be a sign of respect or disrespect Standing too close may be viewed as aggressive or backing up when approached may be viewed as distant Silence may show respect or acknowledgement

13 LEARN Method Listen with empathy and understanding to the pa5ent or person s percep5on Explain your percep5on Acknowledge and discuss the differences and similari5es Recommend treatment/resolu5on Nego5ate treatment

14 Kleinman s Nine Questions 1) What do you call your problem? 2) What do you think caused your problem? 3) Why do you think it started when it did? 4) What does your sickness do to you? 5) How severe is it? 6) What do you fear most about your disorder? 7) What are the chief problems that your sickness has caused for you? 8) What kind of treatment do you think you should receive? 9) What are the most important results you hope to receive from the treatment?

15 Remember... Improvement in communica5on, similar to cultural competence, requires sustained effort. It is an ongoing process that yields great rewards. Improves pa5ent care outcomes Strengthens rela5onships Reduces li5ga5on Enhances professional sa5sfac5on

16 If An Interpreter is Used Qualified interpreter - Trained professional - Governed by interpreters common code of ethics - Basic func5on is to provide transla5on while maintaining a disengaged presence Considera9ons when selec9ng a qualified interpreter: - Dialect - Gender if discussing sensi5ve issues - Appearance/social/ethnic issues - Agtude

17 Research shows... Communica5on without an interpreter poses a risk of misdiagnosis and possible inappropriate treatment Language barriers are associated with significant dispari5es in healthcare access and quality Use of interpreter services can mi5gate dispari5es, improving comprehension and outcomes

18 What do you feel like is the ineluence of cultural displacement on the prevalence of diabetes and other health problems among diverse cultures?

19 Facts About Diabetes and Asians Despite having lower body weight, Asian Americans are more likely than Caucasians to have diabetes. Diabetes is a rapidly growing health challenge among Asians and Pacific Islanders who have immigrated to the United States, affec5ng about 10 % of Asian Americans; about 90 to 95 % of Asians with diabetes have type 2 diabetes. According to the Interna5onal Diabetes Federa5on in 2010, approximately 26.8 million people have diabetes in the United States. But diabetes is also spreading more rapidly in Asia than anywhere else in the world. The World Health Organiza5on and the Interna5onal Diabetes Federa5on (IDF) predict that the diabetes rate in Asia is expected to increase drama5cally by 2030, with India and China together accoun5ng for approximately 150 million people.

20 High Risk Factors for Asians A gene5c suscep5bility to insulin resistance has been suggested as the main predisposing factor Lifestyle factors may be an important determinant in the increased risk of type 2 diabetes amongst South Asians. The HSE has found that Indians, Pakistanis and Bangladeshis are respec5vely 14%, 30% and 45% less likely to meet current guidelines for physical ac5vity than the general popula5on. [23] Qualita5ve study of South Asian women has shown that many barriers exist to increasing physical ac5vity, including other physical ailments, cultural norms, and social expecta5ons.

21 Risk Factors continued Other poten5al environmental determinants of diabetes appear to be more common amongst South Asian popula5ons, such as Vitamin D deficiency, the chewing of Arecha catechu (betel) nut, and a high prevalence of cigareye smoking in some South Asian popula5ons (Bangladeshis and Pakistanis)

22 Examples of Cultural Challenges for Preventing Diabetes in Asians Amongst Bangladeshi people in East London, prayer was frequently cited as sufficient to sustain health, and discordance was observed between people who believed exercise was socially and religiously unacceptable and those that thought it was supported by the religious teaching and the wider community. Social expecta5on of special' foods, a need to cook "in compliance of society's expecta5on The wife's role as provider of tasty meals versus guardian of family health, and the desire to exercise versus fear of social disapproval.

23 Facts About Diabetes and Hispanics The risk of diabetes is 66% higher among Hispanic/La5no Americans than among non- Hispanic white Americans. Hispanics are 1.5 5mes more likely than non- Hispanic whites to die from diabetes. It is the firh leading cause of death in Hispanics in the US. The prevalence of diabetes varies among Hispanic popula5ons: Mexican Americans tend to be more suscep5ble than South Americans to Type 2 diabetes.

24 Risk Factors for Hispanic Population Hispanics are more likely to store fat in their pancreas, but less likely to be able to produce more insulin to compensate for this excess fat, pugng them at higher risk for type 2 diabetes. Mexican Americans are one of the fayest groups in what is one of the fayest na5ons on earth. 3 out of 4 Mexican American adults were either overweight or obese at the end of the 20 th century. Plen5ful and unhealthy diets, many hours of television watching, and a reluctance to exercise are some of the factors blamed.

25 Native Americans and Diabetes Cherokee men and women are twice as likely to be obese as members of other racial and ethnic groups in North Carolina The prevalence rate of type 2 diabetes among Cherokee men and women combined is 23.8%. This rate is more than three 5mes the combined rate for men and women from all other racial and ethnic groups in North Carolina. Diabetes is the fourth leading cause of death among Na5ve Americans according to the CDC.

26 Continued Diabetes rates are highest in full- blooded Na5ve Americans, as first observed in Choctaw Indians in 1965 and subsequently in other tribes. The prevalence of diabetes in residents of the Pima community in Arizona is the highest in individuals of full Na5ve American heritage. About 50 percent of the tribe between the ages of 30 and 64 have diabetes. Prevalence of Type 2 diabetes among all Na5ve American tribes in the United States is 12.2 percent of those over 19 years of age. The prevalence of Type 2 diabetes in Na5ve American communi5es has increased drama5cally during the second half of this century.

27 Risk Factors for Native Americans As is the case with other high- risk popula5ons, research indicates that there is a gene5c basis behind the rise in prevalence of diabetes among Na5ve Americans. Obesity is a major risk factor for diabetes in many tribes, with increasing rates of obesity measured in several communi5es in the United Stated and Canada. This increase can be linked to the tribes move away from tradi5onal diets and lifestyles towards more modern and sedentary ways of life. Increased alcohol use and binge drinking.

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29 References Bertakis, K. D., & Rhaman, A. (2010). Pa5ent- centered care is associated with decreased health care u5liza5on. Journal of the American Board of Family Medicine 24(3), Doolson, L. G. (2000). Adolescent homosexuality and culturally competent nursing. Nursing Forum, 35(3), Groves, W. (2014). Professional prac5ce skills for nurses. Nursing Standard, 29(1), Hadziabdic, E., & Hjelm, K. (2013). Working with interpreters: Prac5cal advice for use of an interpreter in healthcare. InternaAonal Journal of Evidence- based Healthcare, 11,

30 References Ins5tute of Medicine. (2002). Unequal treatment: What healthcare providers need to know about racial and ethnic dispari5es in healthcare. Retrieved from hyps:// Kirwan Ins5tute for the Study of Race and Ethnicity. (2013). State of the science: Implicit bias review. Retrieved from hyp://kirwanins5tute.osu.edu/docs/sots- Implicit_Bias Lehna, C. (2005). Interpreter services in pediatric nursing. Pediatric Nursing, 31(4), Na5onal Council of State Boards of Nursing, Inc. (2012). Kleinman s ques5ons. Retrieved from hyps:// KleinmansQues5ons.pdf

31 Online Resources hyp:// history_declining_health.html- American Indian Health and Diet Project excellent resource on dietary issues for Na5ve Americans hyp://news- prod.wcu.edu/2014/12/wcu- eastern- band- resea arch- project- focuses- on- diabetes- mental- health- issues: examines the rela5onship between mental health issues and diabetes among Cherokee popula5on hyp://aadi.joslin.org/content/asian/why- are- asians- higher- risk- diabetes- examines the reasons Asians are at higher risk for diabetes hyp:// Studies of South Asians and the predisposi5on for developing diabetes.

32 Online Resources continued hyp:// releases/2014/ diabetes- among- hispanics- all- are- not- equal.html#sthash.qpv1fxly.dpuf - describes how diabetes varies among different Hispanic popula5ons. hyp:// ar5clekey= describes factors that may make Hispanics more suscep5ble to diabetes. hyp:// contribu5ng factors to the pandemic of diabetes among Hispanics. hyp://cherokee- hmd.com/cherokee- choices/index.html another useful resource for Na5ve American health choices.

33 More Online Resources hyp://aihc1998.tripod.com/diabetes.html facts about diabetes in the Na5ve American popula5on.