Diabetes among African Refugees: Addressing Risks Awareness through Culturally Sensitive Education

Abstract

Background: The incidence of diabetes and its associated health consequences continue to increase among socio-economically disadvantaged populations. According to the Center for Disease Control and Prevention (CDC), African Americans have an incidence nearly double that of non-Hispanic white Americans at 12.7% vs 7.4% (CDC, 2017). Among African refugees some studies have shown their diabetes incidence increasing the longer they stay in the United States (Wieland et al., 2012; Venters & Gany, 2011). Low risk awareness, enculturation to more sedentary lifestyle, language barriers, and African culture characterized by a reluctance to address or discuss health concerns with people outside of close family all contribute to this trend. Objective: To improve diabetes risk awareness among African refugees who get their services through Refugee Focus (Lutheran Social Services of South West [LSSW]) in Tucson Arizona. Methods: The Quality Improvement (QI) project utilized descriptive statistics to assess participants’ gain in diabetes knowledge as a result of a culturally sensitive education intervention. Pre and Post-test was used to evaluate participant knowledge of diabetes risks, basic facts of the disease, management, and prevention highlights developed from education recommendations by the ADA, the CDC, and the National Institute of Health (NIH). Both the pre-test and post-test contained similar questions to enable assessment of baseline knowledge and corresponding gains attributable to the culturally sensitive education. Settings: Lutheran Social Services of South West (LSSSW) office in Tucson was used as the site for participants recruitment and implementation. The project was approved by the University of Arizona Internal Review Board (UAIRB) to ensure compliance with required conduct of project and protection of human participants. Eight participants enrolled in the project and seven (n=7) completed. Results: Individual pre-test sum scores ranged from 22 to 36 out of possible 36 points maximum score with group mean of 30.9, median of 33. Post-test scores ranged from 33 to 36, group mean of 35.1, median score 33. The results showed significant differences between the pre-test and post-test scores with the mean difference of 4.29 (t6=2.937; 95% C.I: 0.715-7.856; p-value = 0.026). T6 represents a t-distribution with 6 degrees of freedom. All participants with pretest less than the maximum possible score showed some gain in knowledge following the culturally sensitive education. Participants with the lowest education level (fourth grade) generally showed the least baseline knowledge and had the most gain due to the education. Conclusion: Culturally sensitive diabetes education is an effective strategy in increasing awareness of diabetes risks and literacy among refugees receiving services at the LSSSW in Tucson, Arizona. Participants showed significant gains in key aspects of diabetes knowledge tested including risks factors, glycemic management, and lifestyle and diet recommendations for prevention and living with the disease. The project results show that refugees at this location could benefit from getting this information as part of refugee-orientation education. The information has been given to staff at LSSSW to repeat for diabetes awareness or other illnesses identified as a health concern among this refugee population receiving services at this location. Key words: Culturally sensitive education; Diabetic risks, lifestyle and diet recommendation.