Listening to the people you need to help

A one-size-fits-all approach to diabetes education can be alienating to people from CALD backgrounds. DIANE LEDGER explains how she helped develop programs that met the specific needs of two communities.

We’ve long known that people from diverse backgrounds can be at increased risk of diabetes. It’s one of the reasons that we developed DESY – a version of the DESMOND self-management program Diabetes WA has licensed that was specific to and culturally-safe for Aboriginal Australians. The success of that program is proof that we need to move away from a one-size-fits-all approach to diabetes education. When Diabetes Queensland (DQ) got in touch with us to say they were interested in adapting our DESMOND program for two different cultural groups, using the lessons we had learned from DESY, I was really keen to be involved. Their Pacific Islander and Arabic communities had been asking for something in relation to diabetes education, and there was nothing around that was designed to meet that need. So DQ contacted us and asked if we would work with them in adapting DESMOND again, with a different focus.

The main lesson we learned in developing DESY was that the community you’re targeting has to lead the process. We built a cultural adaptation pathway with nine steps that we use when creating material for Aboriginal communities. The process highlights the need to clearly identify the community you’re wanting to reach and to speak to them before you get started. You can’t just go into a community and dump a prepared program on them without talking to them first. We’ve seen what happens when organisations such as ours try to build these sort of targeted programs without doing the community consultation. They tend to quickly fall apart and fail their intended audience. Queensland did an amazing job of consulting with their Pasifika and Arabic communities. They established an expert reference group in which they presented community representatives with the DESMOND program and allowed the community to discuss which elements were relevant to them. Some of the main things they considered were diet and physical activity and making sure that information was appropriate and, where it wasn’t, changing it to meet the community's needs. What makes this adaptation process easier is that DESMOND is all about self-management, about empowering the individual to take control of their diabetes themselves, and I think that resonates with a lot of these community groups. It’s not about going in and saying, 'you must follow this diet and you must take this medication and do this'. It’s very much about working with the person. What we’re doing with DESY and these Pasifika and Arabic versions is extending that individualisation to a larger group. Being culturally appropriate isn’t just about the material. It also means finding educators and facilitators who are part of the community we’re trying to reach. When we find a community educator, we train them up in the DESMOND program and they work alongside a health professional to deliver the sessions. Finding the right person isn’t always easy, but it’s critical if these programs are to succeed.In the past, we’ve tried sending in a diabetes educator who might have been briefed on the community they’re working with, but there’s always a slight disconnection between the audience and what is being presented. You don’t get the same momentum in discussions or investment from the group. It feels too much like we’re imposing ourselves if the information isn’t coming from someone who belongs to that community. The Queensland sessions have proved popular, although COVID has obviously interrupted their delivery. As the pandemic recedes, we’re seeing renewed interest from those communities, which I’m sure will build further in the coming months. Diabetes New South Wales are currently working on their own version of the program, catering to the specific needs of their local Arabic community. We’re hoping the success of DESY here in Western Australia and of the Arabic and Pasifika versions in Queensland will open the door to developing more culturally appropriate DESMOND sessions. We’d love to run those Queensland sessions in our own backyard. Greater funding will help us get those programs off the ground and we’re working hard on securing that. We know there’s a need here from a range of diverse communities and we want to make sure we’re helping them as best we can – and in the way they need to be helped.