Migration and Diabetes

The key goal of this project was to document experiences of diabetes and the factors affecting its risk, prevention, treatment and self-management among recent immigrants (compared to Canadian-born).

Our Research Goals and Methods
Recent immigrants and refugees to Canada (those who immigrated less than 10 years ago) from South Asia, Latin America, the Caribbean and sub-Saharan Africa have a two- to three-times greater risk of developing diabetes than immigrants from Western Europe or North America. There is growing evidence that recent immigrants do not always benefit from diabetes management programs. The study involved adapting and conducting a survey instrument developed by International Centre for Migration and Health that examined diabetes risk, prevention, treatment and self-management practices. We focused the study on four linguistic/cultural groups in Toronto: immigrants from Bangladesh (Bengali speaking), immigrants from Sri Lanka (Tamil speaking), immigrants from Mainland China (Mandarin speaking), and immigrants from Pakistan (Urdu speaking). The final questionnaire was pre-tested and translated into these languages, and was conducted by four trained bi-lingual peer researchers. Survey data was collected from 184 participants (35-64 years old) with self-reported Type 2 diabetes. Of these, 130 were recent immigrants from the four communities and 54 were Canadian-born. We also conducted Focus groups (3) and interviews with health providers from hospitals and CHC’s. The study was conducted in 2009-2010.

Our Project Team Members
This project was led by an interdisciplinary team comprising of Dr Ilene Hyman, Dr Yogendra B. Shakya, Dr Anneke (Joanna) Rummens, Dianne Patychuk, Marisa Creatore, Enza Gucciardi, Bilkis Vissandjée, and Qamar Zaidi (Research Coordinator) , Dragan Kljujic (Data Manager and Survey Programmer). Peer researchers for the project included Sivajini Sivasamy, Khaleda Yesmin, and Ying Zhou.The project was supported by the following advisory committee members: Diabetes Education Project Centre North-East Toronto (DEC NET), AWIC (formerly Asian Women in Canada), West Toronto Diabetes Education Program, Tamil Eelam Society of Canada, Toronto Chinese Health Education Committee, Canadian Diabetes Association (South Asian Chapter), Vasantham –Tamil Senior’s Wellness Centre and Providence Healthcare -Tamil Caregiver Project.

What We Found
Study results show recent immigrants were significantly less likely than the Canadian-born groups to perform regular blood glucose and foot checks, less likely to use a specialist, alternative provider and dietitians, and less likely to report using dietitians, nurses and diabetes organizations as sources of diabetes-related information. Barriers to diabetes care included lack of information on where to go, language barriers, child care issues, and finding a doctor of the same gender. We found 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.

You can read more about our study findings in these publications:

Our Knowledge Translation Activities
We have shared study results in many relevant conferences and symposiums, and directly with decision makers and service providers. 

Our Funders
Under the coordination of the International Centre for Migration and Health (ICMH), this study was commissioned and funded by Public Health Agency of Canada (PHAC).

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