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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Factors affecting the disclosure of diabetes by ethnic minority patients: a qualitative study among Surinamese in the Netherlands

Authors: Mirjam JE Kohinor, Karien Stronks, Joke A Haafkens

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

Diabetes and related complications are common among ethnic minority groups. Community-based social support interventions are considered promising for improving diabetes self-management. To access such interventions, patients need to disclose their diabetes to others. Research on the disclosure of diabetes in ethnic minority groups is limited. The aim of our study was to explore why diabetes patients from ethnic minority populations either share or do not share their condition with people in their wider social networks.

Methods

We conducted a qualitative study using semi-structured interviews with 32 Surinamese patients who were being treated for type 2 diabetes by general practitioners in Amsterdam, the Netherlands.

Results

Most patients disclosed their diabetes only to very close family members. The main factor inhibiting disclosure to people outside this group was the Surinamese cultural custom that talking about disease is taboo, as it may lead to shame, gossip, and social disgrace for the patient and their family. Nevertheless, some patients disclosed their diabetes to people outside their close family circles. Factors motivating this decision were mostly related to a need for facilities or support for diabetes self-management.

Conclusions

Cultural customs inhibited Surinamese patients in disclosing their diabetes to people outside their very close family circles. This may influence their readiness to participate in community-based diabetes self-management programmes that involve other groups. What these findings highlight is that public health researchers and initiatives must identify and work with factors that influence the disclosure of diabetes if they are to develop community-based diabetes self-management interventions for ethnic minority populations.
Literature
1.
go back to reference Stirbu I, Mackenbach JP, Kunst AE, Bos V: Differences in avoidable mortality between migrants and the native Dutch in The Netherlands. BMC Public Health. 2006, 6: 78-10.1186/1471-2458-6-78.CrossRefPubMedPubMedCentral Stirbu I, Mackenbach JP, Kunst AE, Bos V: Differences in avoidable mortality between migrants and the native Dutch in The Netherlands. BMC Public Health. 2006, 6: 78-10.1186/1471-2458-6-78.CrossRefPubMedPubMedCentral
3.
go back to reference Abate N, Chandalia M: Review Articles - Ethnicity, type 2 diabetes & migrant Asian Indians. Indian J Med Res. 2007, 125: 251-PubMed Abate N, Chandalia M: Review Articles - Ethnicity, type 2 diabetes & migrant Asian Indians. Indian J Med Res. 2007, 125: 251-PubMed
4.
go back to reference Burden ML, Woghiren O, Burden AC: Diabetes in African Caribbean, and Indo-Asian ethnic minority people. J R Coll Physicians Lond. 2001, 34: 343-346. Burden ML, Woghiren O, Burden AC: Diabetes in African Caribbean, and Indo-Asian ethnic minority people. J R Coll Physicians Lond. 2001, 34: 343-346.
5.
go back to reference American Diabetes Association: Standards of Medical Care in Diabetes 2008. Diabetes Care. 2008, 31: S12-S54.CrossRef American Diabetes Association: Standards of Medical Care in Diabetes 2008. Diabetes Care. 2008, 31: S12-S54.CrossRef
6.
go back to reference IDF Clinical Guidelines Task Force. Global guideline for Type 2. 2005, Brussels, International Diabetes Federation, Ref Type: Report IDF Clinical Guidelines Task Force. Global guideline for Type 2. 2005, Brussels, International Diabetes Federation, Ref Type: Report
7.
go back to reference Fisher EB, Brownson CA, O'Toole ML, Shetty G, Anwuri VV, Glasgow RE: Ecological approaches to self-management: the case of diabetes. Am J Public Health. 2005, 95: 1523-1535. 10.2105/AJPH.2005.066084.CrossRefPubMedPubMedCentral Fisher EB, Brownson CA, O'Toole ML, Shetty G, Anwuri VV, Glasgow RE: Ecological approaches to self-management: the case of diabetes. Am J Public Health. 2005, 95: 1523-1535. 10.2105/AJPH.2005.066084.CrossRefPubMedPubMedCentral
8.
go back to reference Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, Jack L, et al: Increasing diabetes self-management education in community settings. A systematic review. Am J Prev Med. 2002, 22: 39-66. 10.1016/S0749-3797(02)00424-5.CrossRefPubMed Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, Jack L, et al: Increasing diabetes self-management education in community settings. A systematic review. Am J Prev Med. 2002, 22: 39-66. 10.1016/S0749-3797(02)00424-5.CrossRefPubMed
9.
go back to reference Samuel-Hodge CD: A Randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes. Diabetes Educ. 2009, 35: 439-454. 10.1177/0145721709333270.CrossRefPubMed Samuel-Hodge CD: A Randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes. Diabetes Educ. 2009, 35: 439-454. 10.1177/0145721709333270.CrossRefPubMed
10.
go back to reference McCloskey J: Promotores as partners in a community-based diabetes intervention program targeting Hispanics. Fam Community Health. 2009, 32: 48-57.CrossRefPubMed McCloskey J: Promotores as partners in a community-based diabetes intervention program targeting Hispanics. Fam Community Health. 2009, 32: 48-57.CrossRefPubMed
11.
go back to reference Keyserling TC: A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes - Impact on physical activity. Diabetes Care. 2002, 25: 1576-1583. 10.2337/diacare.25.9.1576.CrossRefPubMed Keyserling TC: A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes - Impact on physical activity. Diabetes Care. 2002, 25: 1576-1583. 10.2337/diacare.25.9.1576.CrossRefPubMed
12.
go back to reference Releford BJ, Frencher SK, Yancey AK, Norris K: Cardiovascular disease control through barbershops: design of a nationwide outreach program. J Natl Med Assoc. 2010, 102: 336-345.CrossRefPubMedPubMedCentral Releford BJ, Frencher SK, Yancey AK, Norris K: Cardiovascular disease control through barbershops: design of a nationwide outreach program. J Natl Med Assoc. 2010, 102: 336-345.CrossRefPubMedPubMedCentral
13.
go back to reference King DK, Glasgow RE, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, et al: Self-Efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care. 2010 King DK, Glasgow RE, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, et al: Self-Efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care. 2010
14.
go back to reference Ford ME, Tilley BC, McDonald PE: Social support among African-American adults with diabetes, part 2: A review. Journal of the National Medical Association. 1998, 90: 425-432.PubMedPubMedCentral Ford ME, Tilley BC, McDonald PE: Social support among African-American adults with diabetes, part 2: A review. Journal of the National Medical Association. 1998, 90: 425-432.PubMedPubMedCentral
15.
go back to reference Samuel-Hodge CD, Headen SW, Skelly AH, Ingram AF, Keyserling TC, Jackson EJ, et al: Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors. Diabetes Care. 2000, 23: 928-933. 10.2337/diacare.23.7.928.CrossRefPubMed Samuel-Hodge CD, Headen SW, Skelly AH, Ingram AF, Keyserling TC, Jackson EJ, et al: Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors. Diabetes Care. 2000, 23: 928-933. 10.2337/diacare.23.7.928.CrossRefPubMed
16.
go back to reference Greenhalgh T: Patient and public involvement in chronic illness: beyond the expert patient. BMJ. 2009, 338: b49-10.1136/bmj.b49.CrossRefPubMed Greenhalgh T: Patient and public involvement in chronic illness: beyond the expert patient. BMJ. 2009, 338: b49-10.1136/bmj.b49.CrossRefPubMed
17.
go back to reference Netto G, Bhopal R, Lederle N, Khatoon J, Jackson A: How can health promotion interventions be adapted for minority ethnic communities? Five principles for guiding the development of behavioural interventions. Health Promot Int. 2010, daq012 Netto G, Bhopal R, Lederle N, Khatoon J, Jackson A: How can health promotion interventions be adapted for minority ethnic communities? Five principles for guiding the development of behavioural interventions. Health Promot Int. 2010, daq012
18.
go back to reference Berlin KS: practical application feature - Impact of diabetes disclosure on perceptions of eating and self-care behaviors. Diabetes Educ. 2002, 28: 809-816. 10.1177/014572170202800521.CrossRefPubMed Berlin KS: practical application feature - Impact of diabetes disclosure on perceptions of eating and self-care behaviors. Diabetes Educ. 2002, 28: 809-816. 10.1177/014572170202800521.CrossRefPubMed
19.
go back to reference Schneider JW, Conrad P: In the closet with illness - epilepsy, stigma potential and information control. Social Problems. 1980, 28: 32-44. 10.1525/sp.1980.28.1.03a00030.CrossRef Schneider JW, Conrad P: In the closet with illness - epilepsy, stigma potential and information control. Social Problems. 1980, 28: 32-44. 10.1525/sp.1980.28.1.03a00030.CrossRef
20.
go back to reference Joachim G, Acorn S: Stigma of visible and invisible chronic conditions. J Adv Nurs. 2000, 32: 243-248. 10.1046/j.1365-2648.2000.01466.x.CrossRefPubMed Joachim G, Acorn S: Stigma of visible and invisible chronic conditions. J Adv Nurs. 2000, 32: 243-248. 10.1046/j.1365-2648.2000.01466.x.CrossRefPubMed
21.
go back to reference Munir F, Yarker J, Haslam C: Use of prescribed medication at work in employees with chronic illness. Occup Med (Lond). 2007, 57: 480-487. 10.1093/occmed/kqm058.CrossRef Munir F, Yarker J, Haslam C: Use of prescribed medication at work in employees with chronic illness. Occup Med (Lond). 2007, 57: 480-487. 10.1093/occmed/kqm058.CrossRef
22.
go back to reference Miglani S, Sood A, Shah P: Self reported attitude and behavior of young diabetics about discussing their disease. Diabetes Res Clin Pract. 2000, 48: 9-13. 10.1016/S0168-8227(99)00131-X.CrossRefPubMed Miglani S, Sood A, Shah P: Self reported attitude and behavior of young diabetics about discussing their disease. Diabetes Res Clin Pract. 2000, 48: 9-13. 10.1016/S0168-8227(99)00131-X.CrossRefPubMed
23.
go back to reference Finucane ML: Making diabetes self-management education culturally relevant for Filipino Americans in Hawaii. Diabetes Educ. 2008, 34: 841-853. 10.1177/0145721708323098.CrossRefPubMed Finucane ML: Making diabetes self-management education culturally relevant for Filipino Americans in Hawaii. Diabetes Educ. 2008, 34: 841-853. 10.1177/0145721708323098.CrossRefPubMed
24.
go back to reference Chesla CA: Accommodating Type 2 Diabetes in the Chinese American Family. Qual Health Res. 2005, 240-255. Electronic Chesla CA: Accommodating Type 2 Diabetes in the Chinese American Family. Qual Health Res. 2005, 240-255. Electronic
25.
go back to reference Bindraban NR, Van Valkengoed IGM, Mairuhu G, Holleman F, Hoekstra JBL, Michels BPJ, et al: Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: A cross-sectional population-based study. BMC Public Health. 2008, 8: Bindraban NR, Van Valkengoed IGM, Mairuhu G, Holleman F, Hoekstra JBL, Michels BPJ, et al: Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: A cross-sectional population-based study. BMC Public Health. 2008, 8:
26.
go back to reference Middelkoop BJ, Struben HW, Kesarlal-Sadhoeram SM, Ramsaransing GN: Diabetes mellitus among South Asian inhabitants of The Hague: high prevalence and an age-specific socioeconomic gradient. Int J Epidemiol. 1999, 28: 1119-1123. 10.1093/ije/28.6.1119.CrossRefPubMed Middelkoop BJ, Struben HW, Kesarlal-Sadhoeram SM, Ramsaransing GN: Diabetes mellitus among South Asian inhabitants of The Hague: high prevalence and an age-specific socioeconomic gradient. Int J Epidemiol. 1999, 28: 1119-1123. 10.1093/ije/28.6.1119.CrossRefPubMed
27.
go back to reference Kendall M, Murray SA, Carduff E, Worth A, Harris F, Lloyd A, et al: Use of multiperspective qualitative interviews to understand patients' and carers' beliefs, experiences, and needs. BMJ. 2009, 339: b4122-10.1136/bmj.b4122.CrossRefPubMed Kendall M, Murray SA, Carduff E, Worth A, Harris F, Lloyd A, et al: Use of multiperspective qualitative interviews to understand patients' and carers' beliefs, experiences, and needs. BMJ. 2009, 339: b4122-10.1136/bmj.b4122.CrossRefPubMed
29.
go back to reference Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al: What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010, 25: 1229-1245. 10.1080/08870440903194015.CrossRefPubMed Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al: What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010, 25: 1229-1245. 10.1080/08870440903194015.CrossRefPubMed
30.
go back to reference Bowen GA: Naturalistic inquiry and the saturation concept: a research note. Qualitative Research. 2008, 8: 137-152. 10.1177/1468794107085301.CrossRef Bowen GA: Naturalistic inquiry and the saturation concept: a research note. Qualitative Research. 2008, 8: 137-152. 10.1177/1468794107085301.CrossRef
31.
go back to reference Beune EJAJ, Haafkens JA, Schuster JS, Bindels PJE: 'Under pressure': How Ghanaian, African-Surinamese and Dutch patients explain hypertension. J Hum Hypert. 2006, 20: 946-955. 10.1038/sj.jhh.1002094.CrossRef Beune EJAJ, Haafkens JA, Schuster JS, Bindels PJE: 'Under pressure': How Ghanaian, African-Surinamese and Dutch patients explain hypertension. J Hum Hypert. 2006, 20: 946-955. 10.1038/sj.jhh.1002094.CrossRef
32.
go back to reference Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N: Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes. Diabet Med. 2006, 23: 1003-1007. 10.1111/j.1464-5491.2006.01922.x.CrossRefPubMed Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N: Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes. Diabet Med. 2006, 23: 1003-1007. 10.1111/j.1464-5491.2006.01922.x.CrossRefPubMed
33.
go back to reference Strauss A, Corbin J: Basics of qualitative research: grounded theory procedures and techniques. 1990, London: Sage Strauss A, Corbin J: Basics of qualitative research: grounded theory procedures and techniques. 1990, London: Sage
34.
go back to reference Trip DM, Willems DL: Respect for human subject involved in medical research. Independence in Research: research code AMC. Edited by: van Kammen J. 2010, Amsterdam: Academic Medical Center, 13-18. 3 Trip DM, Willems DL: Respect for human subject involved in medical research. Independence in Research: research code AMC. Edited by: van Kammen J. 2010, Amsterdam: Academic Medical Center, 13-18. 3
35.
go back to reference Plochg T, Zwieten M: Guidelines for quality assurance in health and health care research: qualitative research. Academic Medical Centre. 2002 Plochg T, Zwieten M: Guidelines for quality assurance in health and health care research: qualitative research. Academic Medical Centre. 2002
36.
go back to reference Munir F, Pryce J, Haslam C, Leka S, Griffiths A: Gender differences in managing chronic illness at work: Exploring predictors for disclosure. J Vocat Rehabil. 2006, 25: 173-180. Munir F, Pryce J, Haslam C, Leka S, Griffiths A: Gender differences in managing chronic illness at work: Exploring predictors for disclosure. J Vocat Rehabil. 2006, 25: 173-180.
37.
go back to reference Modi AC, Quittner AL, Boyle MP: Assessing disease disclosure in adults with cystic fibrosis: the Adult Data for Understanding Lifestyle and Transitions (ADULT) survey Disclosure of disease in adults with cystic fibrosis. BMC Pulm Med. 2010, 10: 46-10.1186/1471-2466-10-46.CrossRefPubMedPubMedCentral Modi AC, Quittner AL, Boyle MP: Assessing disease disclosure in adults with cystic fibrosis: the Adult Data for Understanding Lifestyle and Transitions (ADULT) survey Disclosure of disease in adults with cystic fibrosis. BMC Pulm Med. 2010, 10: 46-10.1186/1471-2466-10-46.CrossRefPubMedPubMedCentral
38.
go back to reference Scambler G: Health-related stigma. Sociol Health & Illn. 2009, 31: 441-455. 10.1111/j.1467-9566.2009.01161.x.CrossRef Scambler G: Health-related stigma. Sociol Health & Illn. 2009, 31: 441-455. 10.1111/j.1467-9566.2009.01161.x.CrossRef
39.
go back to reference Horwitz RH, Roberts LW, Warner TD: Mexican immigrant women's perceptions of health care Access for stigmatizing illnesses: a focus group study in Albuquerque, New Mexico. J Health Care for the Poor and Underserved. 2008, 19: 857-873. 10.1353/hpu.0.0053.CrossRef Horwitz RH, Roberts LW, Warner TD: Mexican immigrant women's perceptions of health care Access for stigmatizing illnesses: a focus group study in Albuquerque, New Mexico. J Health Care for the Poor and Underserved. 2008, 19: 857-873. 10.1353/hpu.0.0053.CrossRef
40.
go back to reference Troster H: Disclose or conceal? Strategies of information management in persons with epilepsy. Epilepsia. 1997, 38: 1227-1237. 10.1111/j.1528-1157.1997.tb01221.x.CrossRefPubMed Troster H: Disclose or conceal? Strategies of information management in persons with epilepsy. Epilepsia. 1997, 38: 1227-1237. 10.1111/j.1528-1157.1997.tb01221.x.CrossRefPubMed
41.
go back to reference Comer LK, Henker B, Kemeny m, Wyatt G: Illness disclosure and mental health among women with HIV/AIDS. J Community & Appl Soc Psychol. 2000, 10: 449-464. 10.1002/1099-1298(200011/12)10:6<449::AID-CASP577>3.0.CO;2-N.CrossRef Comer LK, Henker B, Kemeny m, Wyatt G: Illness disclosure and mental health among women with HIV/AIDS. J Community & Appl Soc Psychol. 2000, 10: 449-464. 10.1002/1099-1298(200011/12)10:6<449::AID-CASP577>3.0.CO;2-N.CrossRef
42.
go back to reference Kalichman SC, Hunter TL: The disclosure of celebrity HIV infection: its effects on public attitudes. Am J Public Health. 1992, 82: 1374-1376. 10.2105/AJPH.82.10.1374.CrossRefPubMedPubMedCentral Kalichman SC, Hunter TL: The disclosure of celebrity HIV infection: its effects on public attitudes. Am J Public Health. 1992, 82: 1374-1376. 10.2105/AJPH.82.10.1374.CrossRefPubMedPubMedCentral
43.
go back to reference Frijda NH, Mesquita B: Beliefs through emotions. Emotions and beliefs: How emotions influence thought. Edited by: Frijda NH, Manstead ASR, Bem S. 2000, Cambridge: Cambridge University PressCrossRef Frijda NH, Mesquita B: Beliefs through emotions. Emotions and beliefs: How emotions influence thought. Edited by: Frijda NH, Manstead ASR, Bem S. 2000, Cambridge: Cambridge University PressCrossRef
44.
go back to reference Hofstede G: Dimensions of national cultures in fifty counties and three regions. Expiscations in cross-cultural psychology. Edited by: Deregowsky J, Dziurawiec, Annis SC. 1983, Lisse: Swets and Zeitlinger Hofstede G: Dimensions of national cultures in fifty counties and three regions. Expiscations in cross-cultural psychology. Edited by: Deregowsky J, Dziurawiec, Annis SC. 1983, Lisse: Swets and Zeitlinger
Metadata
Title
Factors affecting the disclosure of diabetes by ethnic minority patients: a qualitative study among Surinamese in the Netherlands
Authors
Mirjam JE Kohinor
Karien Stronks
Joke A Haafkens
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-399

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