Advertisement

The Arab American experience with diabetes: Perceptions, myths and implications for culturally-specific interventions

  • Elizabeth A. Bertran
    Affiliations
    Eugene Applebaum School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2134, Detroit, MI 48201, USA2
    Search for articles by this author
  • Author Footnotes
    1 Dr. Pinelli was a fellow of Dr. Jaber's at the time of her main involvement in the study. Her present address is as follows: The University of North Carolina Eshelman School of Pharmacy Division of Practice Advancement and Clinical Education CB#7574, 115F Beard Hall, Chapel Hill, NC 27599-7574, USA. Tel.: +1 9199621641.
    Nicole R. Pinelli
    Footnotes
    1 Dr. Pinelli was a fellow of Dr. Jaber's at the time of her main involvement in the study. Her present address is as follows: The University of North Carolina Eshelman School of Pharmacy Division of Practice Advancement and Clinical Education CB#7574, 115F Beard Hall, Chapel Hill, NC 27599-7574, USA. Tel.: +1 9199621641.
    Affiliations
    Eugene Applebaum School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2134, Detroit, MI 48201, USA2
    Search for articles by this author
  • Stephen J. Sills
    Affiliations
    The University of North Carolina at Greensboro, 320 Graham Building UNCG, Greensboro, NC 27402-6170, USA
    Search for articles by this author
  • Linda A. Jaber
    Correspondence
    Corresponding author.
    Affiliations
    Eugene Applebaum School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2134, Detroit, MI 48201, USA2
    Search for articles by this author
  • Author Footnotes
    1 Dr. Pinelli was a fellow of Dr. Jaber's at the time of her main involvement in the study. Her present address is as follows: The University of North Carolina Eshelman School of Pharmacy Division of Practice Advancement and Clinical Education CB#7574, 115F Beard Hall, Chapel Hill, NC 27599-7574, USA. Tel.: +1 9199621641.
    2 Tel.: +1 3135775899; fax: +1 3135775369.

      Highlights

      • There is a lack of data on Arab American diabetes perceptions.
      • Perceptions and cultural preferences will help develop culturally-specific programs.
      • Lifestyle interventions should address myths and folk remedies.
      • Interventions should incorporate cultural content and account for gender norms.
      • Family support and religious centers can enable cost-effective interventions.

      Abstract

      Aims

      Culturally-specific lifestyle diabetes prevention programs require an assessment of population disease perceptions and cultural influences on health beliefs and behaviors. The primary objectives were to assess Arab Americans’ knowledge and perceptions of diabetes and their preferences for a lifestyle intervention.

      Methods

      Sixty-nine self-identified Arab or Arab Americans ≥30 years of age and without diabetes participated in 8 focus groups.

      Results

      Emerging themes from the data included myths about diabetes etiology, folk remedies, and social stigma. The main barrier to healthcare was lack of health insurance and/or cost of care. Intervention preferences included gender-specific exercise, group-delivered education featuring religious ideology, inclusion of the family, and utilization of community facilities.

      Conclusion

      Lifestyle interventions for Arab Americans need to address cultural preferences, diabetes myths, and folk remedies. Interventions should incorporate Arabic cultural content and gender-specific group education and exercise. Utilization of family support and religious centers will enable culturally-acceptable and cost-effective interventions.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N. Engl. J. Med. 2002; 346: 393-403
        • Li G.
        • Zhang P.
        • Wang J.
        • et al.
        The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study.
        Lancet. 2008; 371: 1783-1789
        • Lindstrom J.
        • Peltonen M.
        • Eriksson J.G.
        • et al.
        Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS).
        Diabetologia. 2013; 56: 284-293
        • Pan X.R.
        • Li G.W.
        • Hu Y.H.
        • et al.
        Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.
        Diabetes Care. 1997; 20: 537-544
        • Perreault L.
        • Pan Q.
        • Mather K.J.
        • et al.
        Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study.
        Lancet. 2012; 379: 2243-2251
        • Ramachandran A.
        • Snehalatha C.
        • Mary S.
        • et al.
        The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
        Diabetologia. 2006; 49: 289-297
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N. Engl. J. Med. 2001; 344: 1343-1350
        • Brown B.
        • Noonan C.
        • Harris K.J.
        • et al.
        Developing and piloting the Journey to Native Youth Health program in Northern Plains Indian communities.
        Diabetes Educ. 2013; 39: 109-118
        • Burnet D.L.
        • Plaut A.J.
        • Wolf S.A.
        • et al.
        Reach-out: a family-based diabetes prevention program for African American youth.
        J. Natl. Med. Assoc. 2011; 103: 269-277
        • Faridi Z.
        • Shuval K.
        • Njike V.Y.
        • et al.
        Partners reducing effects of diabetes (PREDICT): a diabetes prevention physical activity and dietary intervention through African–American churches.
        Health Educ. Res. 2010; 25: 306-315
        • Kaholokula J.K.
        • Wilson R.E.
        • Townsend C.K.
        • et al.
        Translating the Diabetes Prevention Program in Native Hawaiian and Pacific Islander communities: the PILI’ Ohana Project.
        Transl. Behav. Med. 2014; 4: 149-159
        • Dallo F.J.
        • Ruterbusch J.J.
        • Kirma J.D.
        • et al.
        A health profile of Arab Americans in Michigan: a novel approach to using a hospital administrative database.
        J. Immigr. Minor. Health. 2015;
        • El-Sayed A.M.
        • Galea S.
        The health of Arab-Americans living in the United States: a systematic review of the literature.
        BMC Public Health. 2009; 9: 272
        • Jaber L.A.
        • Brown M.B.
        • Hammad A.
        • et al.
        Epidemiology of diabetes among Arab Americans.
        Diabetes Care. 2003; 26: 308-313
        • Jaber L.A.
        • Brown M.B.
        • Hammad A.
        • et al.
        Lack of acculturation is a risk factor for diabetes in Arab immigrants in the US.
        Diabetes Care. 2003; 26: 2010-2014
        • Powers M.A.
        • Bardsley J.
        • Cypress M.
        • et al.
        Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.
        Diabetes Educ. 2015; 4: 417-430
        • Hammad A.
        • Kysia R.
        • Rabah R.
        • et al.
        Guide to Arab Culture: Health Care Delivery to the Arab American Community.
        Arab Community Center for Economic and Social Services, 1999
        • Aboul-Enein B.H.
        • Aboul-Enein F.H.
        The cultural gap delivering health care services to Arab American populations in the United States.
        J. Cult. Divers. 2010; 17: 20-23
        • Morgan D.
        Focus Groups as Qualitative Research.
        2nd ed. SAGE Publications, Inc., Thousand Oaks, CA1997
        • Altheide D.L.
        Ethnographic content analysis.
        Qual. Sociol. 1987; 10: 65-77
        • Valente M.J.
        • Guedes de Pinho P.
        • de Lourdes Bastos M.
        • et al.
        Khat and synthetic cathinones: a review.
        Arch. Toxicol. 2014; 88: 15-45
        • Al-Dahir S.
        • Brakta F.
        • Khalil A.
        • Benrahla M.
        The impact of acculturation on diabetes risk among Arab Americans in Southeastern Louisiana.
        J. Health Care Poor Underserved. 2013; 24: 47-63
        • Hekman K.
        • Weir S.
        • Fussman C.
        • Lyon-Callo S.
        Health Risk Behaviors Among Arab Adults Within the State of Michigan: 2013 Arab Behavioral Risk Factor Survey.
        Michigan Department of Health and Human Services, Lifecourse Epidemiology and Genomics Division and Health Disparities Reduction and Minority Health Section, Lansing, MI2015
        • Bertran E.A.
        • Fritz H.
        • Abbas M.
        • et al.
        The impact of Arab American culture on diabetes self-management education.
        Diabetes Educ. 2015; 41: 748-754
        • Nagelkerk J.
        • Reick K.
        • Meengs L.
        Perceived barriers and effective strategies to diabetes self-management.
        J. Adv. Nurs. 2006; 54: 151-158
        • Tessaro I.
        • Smith S.L.
        • Rye S.
        Knowledge and perceptions of diabetes in an Appalachian population.
        Prevent. Chronic Dis. 2005; 2
        • Sulaiman N.D.
        • Furler J.S.
        • Hadj E.J.
        • et al.
        Stress, culture and ‘home’: social context in Turkish and Arabic-speaking Australians’ views of diabetes prevention.
        Health Promot. J. Austr. 2007; 18: 63-68
        • Pinelli N.R.
        • Brown M.B.
        • Herman W.H.
        • Jaber L.A.
        Family support is associated with success in achieving weight loss in a group lifestyle intervention for diabetes prevention in Arab Americans.
        Ethn. Dis. 2011; 21: 480-484
        • Jaber L.A.
        • Pinelli N.R.
        • Brown M.B.
        • et al.
        Feasibility of group lifestyle intervention for diabetes prevention in Arab Americans.
        Diabetes Res. Clin. Pract. 2011; 91: 307-315