Despite the fact that type 2 diabetes disproportionately affects the Chinese community, the current literature and national guidelines on facilitating diabetes self-management have been largely based on Western literature. Enter Dr Tammie Choi - an accredited dietitian and diabetes researcher whose mission is to create a new diabetes education paradigm for Chinese-Australians - where family and community is a central theme. Culturally this is most relevant for the Chinese who see their family and community as a unit.
The International Diabetes Foundation is raising awareness of the impact that diabetes has on the family and support network of those affected, and promoting the role of the family in the management, care, prevention and education of diabetes as part of World Diabetes Day (November 14th). To explore this topic, we sat down with diabetes researcher Dr Tammie Choi, who is advocating for and creating a new diabetes education paradigm for Chinese-Australians - where family and community is a central theme.
Why is it important that we focus on diabetes in the Chinese-Australian community?
We know from the work by the 2010 China Noncommunicable Disease Surveillance Group that diabetes prevalence is as high as 81% in Chinese people over the age of 60 years, and the very worrying fact that diabetes now also affects a high proportion of young Chinese people. Given the Chinese are the third largest migrant group in Australia, and their number is growing, the evidence suggests that the Australian healthcare system is likely to face increasing pressure in providing diabetes care for Chinese-Australians with diabetes.
Tammie, tell us a little bit about your research?
We know from the research conducted by Fisher’s research team from the University of North Carolina that people with diabetes are typically cared for by health professionals for approximately six hours a year, this leaves them 8,760 hours per year caring for themselves. Therefore, health professionals need to maximise the limited time we spend with people with diabetes, facilitating the development of self-management habits. Despite the fact that type 2 diabetes disproportionately affects the Chinese community, the current literature and national guidelines on facilitating diabetes self-management have been largely based on Western literature. My research focuses on exploring culturally tailored communication strategies to facilitate and promote diabetes self-management habits among Chinese-Australians. Specifically, I have been advocating for an alternative diabetes education paradigm for Chinese-Australians with the incorporation of Confucian learning philosophy and Eastern cultural behaviour change motivators. This means the incorporation of detailed prescriptive healthy lifestyle instructions in diabetes education and facilitating self-evaluation to support the adoption of a healthy lifestyle.
The focus of World Diabetes Day this year is the impact that diabetes has on the family and support network of those affected. Through your work with the Chinese-Australian community, how important is the role of the family and support network?
I am very glad the main message of World Diabetes Day this year focuses on the family and support network of the people with diabetes. Culturally this is most relevant for the Chinese who see their family and community as a unit. My research has indicated that effective diabetes self-management education targeted at the Chinese must employ a collective approach, involving family and community around them.
In one of my research case studies, a Chinese lady with newly diagnosed diabetes brought along her family to the diabetes education session. She came in with her husband, her son, her daughter-in-law and even the parents of her daughter-in-law! While it was pragmatic to involve her adult son in language-translation during the session, she also shared that managing her diabetes was a family affair and everyone in the family played a supporting role. Such cultural collective orientation often has a lovely influence on learning about diabetes. Many Chinese-Australians unaffected by diabetes are keen to partake in diabetes education sessions, just so that they gather health-promoting lifestyle information for their friends and families.
Having a dual-employment as a researcher and a dietitian, I am able to translate my research findings to the Chinese Melbournian community. I have piloted the Australian-first Chinese culturally tailored group-education program (named Not Scared of Sugar™) and a Chinese diabetes support group. These culturally-specific diabetes programs create a forum for Chinese with diabetes and their families and friends to meet, exchange self-management experience and support one another.
Your work with the Chinese-Australian community goes beyond conducting research. You’re actively involved in running workshops with local community groups. Tell us a bit more about how this came about, what you’ve been doing and the impact it’s had.
My research journey began with my frustration as a dietitian, attempting and failing to translate national Western-centric evidence-based guidelines in designing diabetes education for Chinese-Australians. Over the years, I have listened to stories from Chinese people with diabetes during my research data collection and synthesised insights from health professionals around the world working closely with the Chinese community with diabetes. I feel empowered and also obligated to go back to where I started, to bring what I found in my research back to the community and deliver diabetes self-management education in a culturally tailored approach informed by my research. With the culturally tailored Chinese diabetes services, I am very glad to see much better clinical indicators among my patients, but more importantly, the Chinese-Australians are engaged in the Australian diabetes services and feel supported to lead a healthy and happy journey with diabetes.
More information
Dr Tammie Choi is an Accredited Practising Dietitian, lecturer and researcher with the Monash University Department of Nutrition, Dietetics and Food. Her research focuses on closing the cultural gap in patient education and higher education. Access Tammie’s research profile here. You can follow Tammie on Twitter via @tammie_choi.
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