The Efficacy of Culture Specific Interventions for Diabetic Asian Americans Research Paper

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Type 2 diabetes is increasing in prevalence across the United States at a rate that cannot be explained by genetics alone. Obesity and inactivity are thought to play a strong role in the notable spike in the number of sufferers. On the other hand, genetics still plays a significant role in the likelihood of developing the disorder. As noted by Nguyen (et al. 2015) type 2 diabetes currently is present in approximately 9% of Asian Americans, with disproportionate numbers among Filipino, Pacific Islander, Japanese, and South Asian groups. Asian-Americans appear to develop type 2 diabetes at lower BMIs than those of other ethnic groups, suggesting the need for greater vigilance of patients’ weights and different clinical guidelines based upon genetic differences. According to a randomized clinical control trial of pre-diabetics (n = 3234) called the Diabetes Prevention Program, development of diabetes was reduced by 58% through a lifestyle education program, although the program was not Asian-American specific (Nguyen et al. 2015).

But even a study of diabetes among a specific population group in and of itself is not homogeneous. In a study by Choi (et al. 2013), gender as well as race was found to significantly affect tendencies to develop type 2 diabetes. Researchers used the California Health Interview Survey (CHIS) 2009, 2011) and examined California adults aged 18 and older (n=46,091 projected to 26.6 million) to determine like likelihood of developing diabetes based upon gender within different ethnic groups. Overall, men had a higher prevalence of diabetes than women, while within certain subcategories such as African-Americans and Korean-Americans, women actually had a higher likelihood of manifesting diabetes.

A systematic review by King (et al. 2012) likewise found that Asian-Americans are more likely to manifest diabetes at lower, even normal BMIs compared with the rest of the population. Additionally, King also confirmed that certain subsets, such as Pacific Asian Americans, are more apt to manifest the condition. On the other hand, the fact that Asian-Americans are such a diverse population can make comparisons extremely difficult. Certain groups are more apt to have second and third-generation status than other populations and socio-economic conditions can vary widely, making it difficult to engage in cross-comparisons between studies. King (et al. 2012) also notes that traditional beliefs may affect how the illness is perceived within the community and should be taken into consideration when making prescriptions about how to treat the population, such as dietary preferences for specific foods, attitudes towards food, and cultural beliefs about health (such as a preference for traditional Chinese medicinal techniques).

As well as systematic reviews, there have also been a number of qualitative case studies which support the idea that systematic interventions can be useful in treating diabetes. In one case study of a Sikh population, community health worker-led interventions in New York City of 175 Sikhs with borderline diabetes used a combination of education and monitoring of BMI, blood glucose, and other health measures to reduce the prevalence of diabetes in this high-risk group (Islam et al. 2014). Sikhs were selected because India has seen a particularly precipitous spike in its diabetes rates as affluence has increased; again, within that national context, even individuals with relatively normal BMIs have manifested diabetes at higher rates and this specific community was used to see if early intervention could improve the health outlook of at-risk patients.

Data was accumulated through private interviews with the participants.

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The focus of the program as a whole was upon interacting with patients in a one-on-one fashion to educate them about risk factors in diabetes. Six sessions were facilitated by the community health worker of two hours in length on the subject of diabetes education. After the six sessions, there was follow-up through phone interviews (Islam et al. 2014). Participants reported a positive effect upon their sense of autonomy and control over their health.

Of course, identifying individuals who are at risk is paramount to ensure such programs are effective. An integrative review by Hsu (et al. 2015) found that in studies of specific Asian populations abroad, Asians with much lower BMIs than in Caucasian populations are still at risk for diabetes-related disorders. Other studies of Asian-Americans specifically focusing on behaviors using indexes such as the Behavioral Risk Factor Surveillance System (BRFSS) found much higher risks for Asians, even when undertaking relatively moderate risk activities that could increase prevalence of diabetes.

Viewed in conjunction, all of these studies suggest that Asian-Americans face certain unique risks regarding their tendency to develop diabetes; they may be more affected by the obesogenic society in which calories are plentiful and physical activity is minimal. This trend holds true in both Asia and in the United States context, implying a genetic component to the risk of diabetes. However, community-specific interventions can be useful to address the needs of diabetes. Healthcare practitioners can use screening devices specific to Asian-Americans, not simply those used for the general population. Interventions designed to target Asian-Americans within a cultural context, preferably those particular to gender and nation-specific group, seem to be more effective. Thus, it is anticipated that the hypothesis of the planned study will be confirmed, and that culturally tailored lifestyle modification programs are likely to be more effective than those which take a more general approach to screening and advice.

Type of Study:

Design Type: Quantitative

Framework/Theory: Multiculturalism

Setting: Pre-diabetic patients in the United States

Key Concepts/Variables: Diabetes education program

Independent variable: Participation in educational program

Dependent: Risk for diabetes

Findings: Statistically significant reduction in diabetes

Hierarchy of Evidence: Randomized Control

Design Type: Descriptive

Framework/Theory: Feminism/ Gender-based

Adult Californians

Concepts: Gender

Independent Variable: Diabetic status

Dependent Variable: Race and Gender

Controlled Variable: Socio-economic status

In certain Asian-American groups, women have a greater likelihood of developing diabetes than women

Descriptive

King, G. L., McNeely, M. J., Thorpe, L. E., Mau, M. L. M., Ko, J., Liu, L. L., … Chow, E. A. (2012). Understanding and addressing unique needs of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders. Diabetes Care, 35(5), 1181–1188. http://doi.org/10.2337/dc12-0210

Type of Study: Quantitative

Design Type: Systematic Review

Framework/Theory: Multiculturalism

Diabetics of various races

Concepts: Different policies needed to address diabetes in Asian Americans

Independent Variable: Race

Dependent Variable: Diabetes

Controlled Variable: Socio-economic status

Asian-Americans are a multifaceted category and require different approaches to effectively address diabetes

Systematic review

Islam, N. S., Zanowiak, J. M., Wyatt, L. C., Kavathe, R., Singh, H., Kwon, S. C., & Trinh-Shevrin, C. (2014). Diabetes prevention in the New York City Sikh Asian Indian Community: A pilot study. International Journal of Environmental Research and Public Health, 11(5), 5462–5486. http://doi.org/10.3390/ijerph110505462

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