Screening for Diabetes and Risks among Black African and Caribbean Residents in Toronto
Screening for Diabetes and Risks among Self-Identified Black African and Caribbean (ACB) Residents in Toronto Aged 18-39 years: A Collaborative CHC Study Supporting the CANRISK Tool
Project overview
Context
The prevalence of diabetes has increased significantly over the last years among younger adults in Canada, with Black individuals being disproportionately affected causing worse complications that include organ damage.
The Public Health Agency of Canada (PHAC) developed the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) tool to screen for and support diabetes management nationwide. However, it could not capture adequate data for African and Caribbean Black (ACB) individual aged 18-39 years. PHAC approached Access Alliance, Rexdale, Taibu, and Black Creek Community Health Centres to address this gap by identifying the risk and prevalence of diabetes in this population. Access Alliance MHCS led this collaborative initiative to train the staff of the partner CHCs on conducting ethical Community-Based Research to collect sensitive data from a sensitive population group. The activities and findings reflected here are based only on Access Alliance’s study data.
Key learning:
- Diabetes impacts ACB communities disproportionately. ACB individuals are vulnerable to diabetes, more than they are aware of.
- Using HbA1c as a primary screening tool captures more diabetes and pre-diabetes than the Oral Glucose Tolerance Test (OGTT) in ACB communities. As a test procedure, HbA1c is more culturally acceptable to this population group.
- The average HbA1c of ACB individuals is higher than the Canadian standard for non-diabetes level.
- The food behaviour and preferences ask for culturally competent health promotion strategies that consider the unique behavioural and dietary patterns of ACB individuals. Collaborative efforts among Community Health Centres and Public Health agencies are essential to generate more longitudinal evidence to address this pressing health issue.
- This project provides a replicable approach to filling CANRISK data gaps in culturally competent ways that can be used with other populations and groups.
Research Overview
This was a mixed-methods (quantitative and qualitative) study. The project specifically compared different testing methods (HbA1c, FPG, and 2hPG) to determine the most effective screening approach for this population while identifying key risk factors for diabetes and pre-diabetes. Height, weight, waist circumference, and blood pressure were measured along with the relevant behavioural and family history. Interpretive Phenomenological analysis approach was adopted to interpret individual data.
Key context:
- Current screening techniques may not adequately capture diabetes risk in young ACB populations
- Early detection is crucial for better disease management and prevention of complications
- Many people with prediabetes or early diabetes remain undiagnosed
- Immigration and socioeconomic factors significantly impact diabetes risk in ACB communities
Our Research Goals and Methods
The study employed a mixed-method approach with three main research questions:
- What is the percentage of diabetes and prediabetes among ACB residents in Toronto?
- What factors relate to blood sugar levels and diabetes/pre-diabetes risk?
- What effective culturally acceptable health promotion measures for can prevent and treat diabetes?
Our approach involved:
Community-Based Participatory Research (CBPR)/ Asset Based Community Development Framework / Appreciative Inquiry
- Engaging community members as active partners in the research process
- Promoting a peer-research model, where researchers were trained in Community-based research methods and the collection of sensitive data from vulnerable populations
- Designing studies that respect and reflect cultural context
Ethical Considerations
- Ensuring research practices are ethical and culturally affirming/safe
- Protecting the rights and dignity of participants
- Adopting the Engagement, Governance, Access, and Protection (EGAP) framework for Black Health Equity in Research
Feedback Loops
- Incorporating community feedback into research conclusions and future studies
- Ensuring the community benefits from the research outcomes
Accessible Recruitment Materials Reporting
- Presenting research findings in ways that are understandable and useful to the community
- Using various media and formats for a wider reach
Methodology:
- Recruited 272 participants who migrated from 14 African and five Caribbean countries
- Participants were recruited from diverse ACB communities through community outreach and peer referrals.
- Conducted blood tests using HbA1c, FPG, and 2hPG measurements
- Administered the CANRISK questionnaire to assess risk for diabetes
- Performed qualitative analysis through interviews with selected participants
What We Found/What We Learned
What is the percentage of diabetes and prediabetes among ACB residents (Toronto) aged 18–39 years old?
HbA1c testing proved more sensitive in detecting diabetes compared to FPG and 2hPG measures. 1.5% of participants were diagnosed with diabetes, while 9.2% were identified as pre-diabetic. Additionally, 44.9% were determined to be at risk for diabetes.
Recommended Screening Practice: Using HbA1c as a primary screening tool identifies a higher prevalence of diabetes and pre-diabetes. It captures more cases of diabetes and pre-diabetes than fasting plasma glucose measures. Implement HbA1c testing as a standard screening method in ACB communities to enhance early detection and management of diabetes.
What are the factors related to blood sugar levels/diabetes/pre-diabetes in these populations?
The study identified several key risk factors:
- There is a clear correlation between BMI/waist circumference and diabetes risk
- Diet (high-calorie content food consumption) and lifestyle changes post-migration influenced diabetes risk
- Eating patterns, such as late-night eating habits
- Limited physical activity
- Mental health issues (anxiety/depression) related to immigration emerged as a significant factor
How can health promotion measures effectively prevent/treat pre-diabetes and diabetes among the ACB population?
For Healthcare Providers:
Recommendations for Healthcare Providers:
- Consider immigration-related factors in diabetes risk assessment
- Integrate cultural and lifestyle factors into treatment plans
- Implement more sensitive screening measures using HbA1c testing
- Develop targeted interventions for young ACB adults
- Incorporate mental health support in diabetes prevention programs
Using HbA1c as a primary screening tool not only identifies a higher prevalence of diabetes and pre-diabetes but also enables timely interventions to reduce long-term health complications. Collaborative efforts among community health centres and public health agencies are essential to address this pressing health issue.
This project provided additional learning in terms of approaches to community healthcare. While researchers focused on recruitment, another primary goal was meaningful community engagement and building trust. By being community-centric, they were successful in recruitment. They were also able to build trust by creating safe spaces and employing staff who represent the community.
It is important to do intentional and continuous work toward Black health equity and support in health planning. Key recommended practices include increasing health promotion efforts targeting lifestyle modifications (diet and physical activity) to mitigate diabetes risk among ACB populations. The focus should be on the most at-risk groups identified through community-specific outreach and education initiatives. Ensuring Black populations are engaged in the analysis and use of data in the development, delivery and monitoring of services. It is important to do intentional and continuous work toward Black health equity and support in our health planning.
Community Organizations:
The community has a diversity of needs and approaches to engagement. Word-of-mouth continues to be an important part of a communication and recruitment strategy. Community involvement and feedback is essential for successful health promotion initiatives.
- Create culturally-specific diabetes prevention programs
- Provide support for recent immigrants adjusting to lifestyle changes
- Implement mental health support services alongside diabetes programs
Policy Makers:
A peer-research model influenced efficient outreach and recruitment from representative samples from the population. In order to reach, recruit, and serve ACB communities, it will be important to increase funding for the recruitment, retention and promotion of Black staff.
- Consider assigning a culturally adaptable HbA1c cut-off for screening diabetes.
- Develop targeted diabetes prevention strategies for ACB communities
- Address social determinants of health affecting diabetes risk
- Allocate resources for culturally appropriate diabetes education
Our Knowledge Translation Activities
Journal article
Presentation slides:
Implementation Research for testing the CANRISK Tool Screening for Diabetes among African, Caribbean, and Black Adults (18 39). Alliance Conference: Co-designing the Future of Primary Health Care June 6, 2024; Toronto
CANRISK Diabetes Screening in ACB Residents in Toronto: Access Alliance Data. PHAC/PHO Retreat Mid-term evaluation: April 9, 2024
Diabetes Action Canada has designed audience-specific infographic information products. Click on each image for a PDF of the complete infographic.
Black African and Caribbean Communities
South Asian Communities
Our Project Team
Access Alliance:
- Cliff Ledwos- Project Owner
- Akm Alamgir- Research Lead
- Osezua Momoh- Immigrant Peer-Scholar
University of Toronto:
- Rhea Raghunauth- Peer-volunteer and script writer
For more information contact: TalkToUs@accessalliance.ca OR research@accessalliance.ca