Interventions to prevent cardiovascular disease (CVD) and type II diabetes in migrants and other under-served populations C O’Donnell, A Isaacs, K Duncan, L Yeoman, N Burns, S Macdonald General Practice & Primary Care, Institute of Health & Wellbeing

Global challenge of NCDs

GBD 2015 Risk Factors Collaborators. The Lancet 2016: 388; 1659

Aim To explore how migrants and/or health care professionals perceive and discuss preventive care for CVD and type II diabetes. To identify whether the focus of interventions is on individual behaviour or structural determinants.

Approach Systematic review focussed on qualitative studies. Narrative synthesis underpinned by two theoretical frameworks: Candidacy (Dixon-Woods et al, 2016; Mackenzie et al, 2013) Structural vulnerability (Quesada et al, 2011; Bourgois et al, 2017)

Financial security Residence Risk environment Discrimination Power Health literacy Legal status Social networks Mackenzie, O’Donnell et al. Social Policy & Administration 2013; 47: 806 (doi:10.1111/j.1467-9515.2012.00864.x)

Approach Searched medical and sociological databases, 1995 to 2014. Migrants/asylum seekers/refugees/minority groups. CVD/diabetes. English language. Qualitative studies.

Studies included Year of publication 1995 - 1999 3 2000 - 2004 5   1995 - 1999 3 2000 - 2004 5 2005 - 2009 2010 - 2014 18 Country setting USA 20 UK Australia 2 Netherlands Canada 1 Germany New Zealand Norway

Population studied   South Asians 8 Hispanics/Latinos 9 Indigenous populations 7 African-Americans 2 Recent migrants/Refugees 5 Area of focus CVD prevention 3 CVD risk perception Diabetes prevention 11 Diabetes risk perception General view of health and prevention

Candidacy versus Structural Vulnerability People have to identify as being at risk. Differences in recognition of risk factors Diet < smoking and alcohol. Stress often cited. Others important in identification – family, professionals Permeability of intervention. Can it fit into daily life? Cultural and language tailoring important.

Candidacy versus Structural Vulnerability Assertion of candidacy. Continual process – with family; in wider social networks. Necessary to maintain lifestyle change. Adjudication by professionals. Professionals often judge on biomedical evidence – often contested by the individuals. One-to-one support can be helpful. Wider operating conditions. Considered less in the literature. Impact of racism and discrimination recognised, especially in relation to stress.

Candidacy versus Structural Vulnerability Who is at risk considered in biomedical terms. Risk seen as an individual responsibility. Wider ‘responsibility’ for risk not considered. Interventions target the individual. Little discussion of power. Culture considered only in relation to the intervention Wider structural environment e.g. access to food; impact of racism; poverty. Little consideration of legal status, except for undocumented workers.

Going forward Collaborative, co-design approaches needed. Interventions need to be culturally & language appropriate. BUT Interventions also need to address people’s own perceptions of health and risk. Interventions must address wider social structures including impact of legal status/entitlement, poverty and people’s ability to live healthily.

Thank you. Kate.O’Donnell@glasgow.ac.uk @odo_kate /glasgowuniversity @UofGlasgow UofGlasgow Search: University of Glasgow #UofGWorldChangers