CHRONIC DISEASE SELFMANAGEMENT AMONG IMMIGRANTS AND REFUGEES Rosalinda Chen1, AKM Alamgir2, Nicole Nitti2 1. University of Toronto 2. Access Alliance Multicultural Health and Community Services
Presenter Disclosure Presenters: Rosalinda Chen, Dr. Nicole Nitti Relationships to commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None
Disclosure of Commercial Support This program has received financial support from [none] in the form of [n/a]
This program has received in-kind support from Access Alliance Multicultural Health and Community Services in the form of research and logistical support.
Potential for conflict(s) of interest: N/A
Mitigating Potential Bias
N/A
Background
Background
Newcomers
Chronically Ill
Self-Management Barriers
Explore barriers to self-management experienced by Access Alliance primary care clients, and develop agencylevel recommendations for self-management support
Methods In-Depth Interviews ■ Access Alliance Clinicians and Staff – n=10 – Thematic Analysis
Methods Systematic Literature Review ■ Participant and study characteristics – Hispanic > African Americans > East Asians – Type 2 Diabetes Mellitus – Study Location: USA, UK, Canada
BARRIERS TO SELFMANAGEMENT
1) Social Isolation “A state where people are deprived of the support provided by other individuals� (Berg et al., 1990)
Social Isolation Low motivation Other priorities Baumann et al., 2012 Nam et al., 2011 Jerant et al., 2005
Reduced disease selfmanagement
2) Health Literacy “The degree to which individuals have the capacity to obtain, process and understand health information needed to make health decisions.� (Institute of Medicine)
English Language Illiteracy Low Health Knowledge Shaw et al., 2012 Williams et al., 1998 Nam et al., 2011
Low Health Literacy
Reduced SelfManagement
3) Socioeconomic Status “Social
standing or class of individual…often measured as combination of education, income, and occupation” (American Psychological Association)
Low Income Employment
Baumann et al., 2012 Nam et al., 2011
Reduced SelfManagement
4) Mental Health
Depression Post-Traumatic Stress Disorder
McKenzie et al., 2009 Anderson et al., 2015
Reduced SelfManagement
CURRENT STRATEGIES
Current Strategies
PROPOSED SOLUTIONS
1) Group Support Program
In The Literature‌ Gregg et al., 2007
Group interventions reduce social isolation
Rosal et al., 2011
Gucciardi et al., 2013
Self-management interventions delivered in group settings have behavioral and clinical benefits
2) Peer Support Interpretation System Navigation Accompaniment
In The Literature… Creamer et al., 2015
Cabello et al., 2014
Gucciardi et al., 2012
Interventions delivered by peers are significantly associated with behavioral benefits and clinical improvements ■ Participants may associated peers with increased credibility ■ Peers can provide culturally tailored support
Ferguson et al., 2015
3) Comprehensive Individual Counselling
4) Mental Health Support
5) Provider Support
Awareness of Resources
Training
Administration Support
Sharing Strategies
In The Literature‌
Limited evidence that achieved HbA1c reductions were sustained 12 months post-intervention
Tackling underlying barriers beyond disease-specific selfmanagement behaviors required to achieve long-term benefits
Limitations ■ Study mainly involved perspectives of AA clinicians, rather than patients themselves ■ A minority of patient interactions may be overrepresented in provider perceptions ■ However, study can guide future investigations
Conclusions Interdisciplinary, comprehensive approach to self-management support is needed to achieve long-term health benefits
Next Steps Gain Client Perspective Needs Assessment
Questions?
Discussion – Break-Out Sessions Group 1 - Peers
• What chronic disease self-management strategies have been present in agencies that you have worked in? Successes? Limitations? • Do you think the use of peers are effective in supporting selfmanagement? Current practice strategies? • If you had a genie, what would your 3 wishes be with respect to implementing peer support? Which of those wishes could be implemented in the next 1-2 years?
Discussion – Break-Out Sessions Group 2 – Mental Health Support • Do you think that mental health support is effective in supporting self-management? Current practice strategies? • If you had a genie, what would your 3 wishes be with respect to implementing mental health support? Which of those wishes could be implemented in the next 1-2 years? • Do you think that supporting the underlying barriers to selfmanagement beyond disease education (such as mental health challenges or social barriers) is feasible for an individual agency?
Discussion – Break-Out Sessions Group 3 –Provider Support • What chronic disease self-management strategies have been present in agencies that you have worked in? Successes? Limitations? • Do you think that enhancing provider support is effective in supporting self-management? Suggested practice strategies? • If you had a genie, what would your 3 wishes be with respect to enhancing provider support? Which of those wishes could be implemented in the next 1-2 years?