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Learning to live with type 1 diabetes from the perspective of young non-western immigrants in Denmark
Nordic Council of Ministers, Nordic School of Public Health NHV.
Nordic Council of Ministers, Nordic School of Public Health NHV.
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 11, 300-309 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives.  To explore how young adults with a non-western immigrant background and type 1 diabetes since childhood/adolescence have perceived learning to live with the disease, with special focus on health education and support.

Background.  A national Danish study found significantly poorer metabolic control in non-western immigrant children and adolescents as compared with ethnic Danes. Subsequent studies have primarily focused on immigrant parents, whereas little is known about how immigrant children/adolescents have perceived the diagnosis and the diabetes care and support provided.

Design.  A mixed quantitative and qualitative design was applied. This included data on metabolic control for 2002–2006 and semi-structured interviews in 2006 with eleven strategically selected young immigrants. Data were analysed using qualitative content analysis.

Findings.  The findings are described in three thematic categories: Perceptions and reactions at the time of diagnosis; Learning to manage the disease; Present and future life with diabetes. Some findings were similar to those in studies describing children and adolescents of western origin, but the participants also shared perceptions which appeared to be related to their immigrant background. Above all, they described their parents as having difficulty coping with the disease and providing them with sufficient support.

Conclusions.  The diagnosis of diabetes in immigrant children and adolescents requires special pedagogic and psychosocial approaches to bridge the gaps related to culture and traditions and introduce the concept of diabetes management, not least to the parents, in a more optimum way.

Relevance to clinical practice.  Diabetes care should be a continuous and holistic process, constantly aiming to explore existing knowledge and the need for additional education and support for both the patient and his/her family. Special attention should be paid to the fact that immigrants may have limited pre-knowledge of chronic diseases in childhood, including the concept of selfcare.

Place, publisher, year, edition, pages
2008. Vol. 17, no 11, 300-309 p.
Keyword [en]
Adaptation, Diabetes care, Health Education, Support, Type 1 Diabetes, Young Non-Western Immigrants
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3451OAI: oai:DiVA.org:norden-3451DiVA: diva2:755699
Available from: 2014-10-15 Created: 2014-10-15 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Diabetes in children and adolescents from non-western immigrant families: health education, support and collaboration
Open this publication in new window or tab >>Diabetes in children and adolescents from non-western immigrant families: health education, support and collaboration
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: The general aims of this thesis were 1) To explore how non-western immigrant families’ different background and factors related to immigration and acculturation may affect the outcome of education and support in paediatric diabetes management; 2) To provide knowledge on how diabetes education and support for immigrant children and their families should be given to ensure them adequate competence in disease management and the children optimum metabolic control. Methods: The thesis comprises five studies carried out 2001-2006. Study I was based on national register data on metabolic control (N=977), questionnaires to all 20 Danish paediatric diabetes centres and structured interviews with 38 immigrant families. Study II was an intervention study including the development of guidelines and adapted educational material, followed by a re-education programme for 37 families. Study III was a case study of 11 Turkish and Kurdish children/families comprising data from medical records, a participant observation and qualitative interviews with the parents, one interpreter and three diabetes team members. Study IV included qualitative interviews with Arabic parents of 12 children, living as immigrants in Denmark and in Cairo/Egypt respectively. Study V comprised data on metabolic control and qualitative interviews with 11 young adult immigrants with type 1 diabetes since childhood or adolescence.Findings: The young immigrants were very unevenly distributed between the Danish paediatric centres. Most teams had little knowledge of and no special educational offers for immigrant families, just as the use of professional interpreters was limited. The immigrant parents had clearly different pre-conditions for diabetes education as compared with ethnic Danish parents, just as most had a low level of acculturation as evaluated by their need for an interpreter. Major differences were identified between the different ethnic groups and between the individual immigrants. The immigrant children and adolescents had different pre-conditions as compared to their parents; most, however, had non-optimum metabolic control. The design of an adapted educational programme could optimise the outcome of diabetes education, but was not sufficient to provide the families with competence in diabetes management and the children/ adolescents with good metabolic control of long duration. Many parents in particular experienced difficulty combining diabetes management with their principles relating to good parenthood. In addition, they appeared to be insecure and doubtful about the competence of the Danish health care professionals.Conclusions: A different ethno-cultural background is likely to create barriers to health education, learning and collaboration. The non-homogeneity of non-western immigrant families requires educational initiatives tailored to the pre-conditions and needs of the individual family members; adapted initiatives such as peer education are suggested. Special support for immigrant children and adolescents should be considered. A close, supportive and trust-filled relationship between the families and health care professionals is needed to facilitate learning, collaboration and good metabolic contro

Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden, 2008. 63 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2008:1
Keyword
Non-western Immigrants; Children; Adolescents; Parents; Type 1 Diabetes; Health Education; Support; Collaboration; Adaptation; Public Health; Health Promotion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3469 (URN)978-91-85721-24-5 (ISBN)
Public defence
2008-01-22, 13:00 (Danish)
Opponent
Supervisors
Available from: 2014-10-21 Created: 2014-10-21 Last updated: 2014-10-21Bibliographically approved

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