1. The Challenge of CDx2 Health: Cultural Diversity & Health The Challenge of CDx2 Health: Cultural Diversity & Health Self-Management Chronic Illness Alliance CDSM Special Interest Group Meeting Thursday 13 August 2009 @ Latrobe University, Melbourne City Campus John Lawrence, BBSc(Hons) Dip Ed

2. Seminar Aim To explore some issues & strategies which might improve To explore some issues & strategies which might improve Health Self Management Health Self Management for people from Culturally and Linguistically Diverse for people from Culturally and Linguistically Diverse (CALD) Backgrounds (CALD) Backgrounds

3. Overview Traditional Service Model Solution: Health Self-Management Problems & Prospects for Current Models CALDiversity, Social Determinants & HSM – Managing Diabetes in Hispano Populations Challenges & Steps Forward

4. A Traditional Service Model Unlimited growth in service demand Unlimited growth in service demand Client expectation of unlimited service access Client expectation of unlimited service access Client dependency – clogging the service Client dependency – clogging the service No increased budget No increased budget Need for measurable outcomes from funders to secure ongoing funds Need for measurable outcomes from funders to secure ongoing funds DIFFICULTY IN ACCOMMODATING NEEDS OF DIVERSE POPULATIONS including CALD clients DIFFICULTY IN ACCOMMODATING NEEDS OF DIVERSE POPULATIONS including CALD clients >>>>>An Impetus for Change >>>>>> >>>>>An Impetus for Change >>>>>>

5. Acute Chronic Episodic Episodic Cure expected Cure expected QOL highly dependent on professional care QOL highly dependent on professional care QOL highly dependent on short term services QOL highly dependent on short term services HP generally the expert HP generally the expert Short term goals Short term goals Compliance expected Compliance expected Ongoing Incurable QOL highly dependent on Pts SM +decision making QOL highly dependent on ongoing support services Pt often has more knowledge Short term goals to meet long term outcomes Compliance and self reliance expected

6. What is Health Self-Management ? “Involves [the person with health challenges] * engaging in activities that protect and promote health, * monitoring and managing of symptoms and signs of illness, * managing the impacts of illness on functioning, emotions and interpersonal relationships and * adhering to treatment regimes.” ADAPTED from Centre for Advancement in Health (1996) ADAPTED from Centre for Advancement in Health (1996)

7. Benefits of HSM – International (& Aust?) Evidence Improved health Improved health Reduction in hospital admissions, unplanned GP visits and emergency visits Reduction in hospital admissions, unplanned GP visits and emergency visits Increased self efficacy and satisfaction Increased self efficacy and satisfaction Better clinical outcomes Better clinical outcomes More efficient clinical practice More efficient clinical practice Cost savings?? Cost shifting?? Cost savings?? Cost shifting??

8. Problems and Prospects for Current Models of HSM Need to integrate ‘social determinants of health’ Need to integrate ‘social determinants of health’ Damnably hard to implement without wide-ranging health systems change vs CBT-based & individual training models (eg. use WAGNER model) Damnably hard to implement without wide-ranging health systems change vs CBT-based & individual training models (eg. use WAGNER model) Requires flexibility in diverse individuals & social contexts vs. rigid formulaic models / ‘mainstream’ models for educated, middle class, well-integrated ‘worried well’ Requires flexibility in diverse individuals & social contexts vs. rigid formulaic models / ‘mainstream’ models for educated, middle class, well-integrated ‘worried well’ Requires responsiveness to cultural factors Requires responsiveness to cultural factors

9. Local Evidence: CALD & CDSM Sverison, Belfrage et al (2006) Latrobe Uni team/ Sharing Health Care Initiative Sverison, Belfrage et al (2006) Latrobe Uni team/ Sharing Health Care Initiative Italian, Greek, Chinese, Vietnamese Italian, Greek, Chinese, Vietnamese Stanford course Stanford course Modest outcomes / minor sustainability esp’y in Italian, Greek female participants Modest outcomes / minor sustainability esp’y in Italian, Greek female participants Scepticism among professionals Scepticism among professionals

10. Recent Further Local Examples Sulaiman et al (2007) Diabetes prevention in Turkish & Arabic-speaking Australians … Sulaiman et al (2007) Diabetes prevention in Turkish & Arabic-speaking Australians … > not just cultural factors but social context: exclusion & racism > not just cultural factors but social context: exclusion & racism Furler et al (2008) Emotional context of SM Furler et al (2008) Emotional context of SM > emotional base for self-constructing SM shaped by culture > need for HP’s to investigate > emotional base for self-constructing SM shaped by culture > need for HP’s to investigate

11. CALDiversity, Social Determinants & HSM Managing Diabetes in Hispano Populations What are the key barriers to diabetes SM here? Have any key barriers or issues been overlooked? What strategies are identified here? What major strategies would your group recommend to improve diabetes SM in this CALD population?

12. Challenges & Steps Forward Marginalisation of ‘CALD’ factor in national health policy & related statements Marginalisation of ‘CALD’ factor in national health policy & related statements eg. ‘Healthier Australia’, July 2009 > focus on mental health, Aboriginality & social inclusion eg. ‘Healthier Australia’, July 2009 > focus on mental health, Aboriginality & social inclusion Some encouragement eg. ‘Active Service Model’ (HACC) Some encouragement eg. ‘Active Service Model’ (HACC) Need development, documentation & dissemination of ‘good practice’ models & case studies (eg. dementia handout) Need development, documentation & dissemination of ‘good practice’ models & case studies (eg. dementia handout)