Engaging with patients: diabetic care for ethnic minorities in Lothian Presentation to Lothian Diabetes Conference Smita Grant Dermot Gorman Sheila Wilson 9th September 2014 Radisson Blu, Edinburgh

Outline Minority ethnic groups – what the census says Lothian diabetic attendances Edinburgh research Different expectations and service models Development needs

Migrating populations, : 175 million; >4x increase from : 230 million Sources: Population Action International 1994, IOM 2003

Migration trends Scotland (2011 census) The 2011 census results emphasise the increasing diversity of the Scottish population. Each main ethnic group has a different history migration to Scotland with South Asian (Indian, Pakistani and Bangladeshi) and Chinese being the longest established (the Indian and Chinese groups have doubled in size between the 2001 and 2011 censuses and Pakistanis increased by 50% in the same period). There has been a dramatic post 2004 increase in new European migrants from A8 countries, particularly Poland. Poles now comprise 1.2% of the Scottish population. The 2011 census reported that 61,000 Poles, 49,000 Pakistanis, 33,000 Indians, 4,000 Bangladeshi and 34,000 Chinese lived in Scotland

Types of migration  Migration takes many forms:  Voluntary migration – mainly economically motivated in the 20 th Century  Forced migration - people forced to move for reasons of conflict and political repression  International tourism, adoptions and education – have increased dramatically over the past 50 years

Diabetic OP numbers Lothian Diabetic register numbers Pakistani 290 Indian 135 Polish 93 African 64 Chinese 62 Bangladeshi 40

South Asians & diabetes 4x more common in UK resident people of SA origin Higher risk of complications Higher mortality

Lothian based research on South Asians Patients perceptions and understanding of need to adhere to treatment ‘perceptions of OHAs may partly derive from popular ideas about drugs on the Indian subcontinent’ SA passive about developing diabetes – ‘externalising responsibility / highlighting life circumstances in general / their experience in migration (vs Scots who emphasise the role of their lifestyle ‘choice & personal failings’ Complications linked to low PA – SA have perceptions and cultural barriers which may mitigate against PA

Ethnicity and diabetes Scenario Mrs Yunus is in her late 50s, and needs to lose some weight – the doctor wants to discuss with her how she could increase her levels of physical activity in order to do this. Mrs Yunus looks after her 2 grandchildren every day (one in primary school, one pre-school), and feels that she gets plenty of exercise running round after them.

Scenario (cont’d) She fetches the oldest one from school and then provides a meal for them. She also feels that at her age it is perfectly normal and acceptable to put on weight, and doesn’t really see it as a problem.

What sort of questions would you need to ask to find out more about what kind of physical activity Mrs Yunus might be able to incorporate into her life? And what help she might need?

Resources and help Approaches: e.g. Teachback, check understanding that exercise sustains health and mobility for longer, building into daily life etc Possible incentives? Appropriate groups for support in the community Resources e.g. Peoples Voices on Healthier Lifestyles in English/Urdu s.uk/peoplesvoices/) s.uk/peoplesvoices/

Actions you could take at ‘your work’ 1 2 3

He would have said: Care is ‘medical’ led by physicians Diabetic specialist nurses rare General Practice is being developed Some most modern therapies not available Standard protocols e.g. in pregnancy may differ Poland has 38.5m population & 2-2.5m diabetic ( % of which 10% type 1). Mixed public and private health provision

Materials e.g. Living It Up Pilot website co-designed with users Health section includes new digital postcards on diabetes:

Thoughts re other groups?

Summary Variation in diabetes by ethnic group –Incidence different –Presenting groups will change –Patient and family understanding of the condition and pattern of care –Understanding re. diagnosis & adapting to the condition –Outcomes Challenges for staff in managing client expectations & culture Language / interpreters ‘culture’ more generally Moving forward what training might help