Topics covered in this conference and workshops include: paediatric eczema management; gastroenterology; fertility; ophthalmology; ECG interpretation; diabetes management; musculoskeletal examinations;  and joint injections.

To find out more, including registration details, go to:  http://acma.org.nz/acma-conference-2015/

In the latest issue (attached below): 

Fifty-six articles were included. "Four themes emerged through postcolonial feminist analysis: (1) dichotomy between Chinese 'culture' and Western medicine, (2) essentialization of health beliefs and practices, (3) critique of Western healthcare services delivery from Chinese immigrant women's perspectives, and (4) erasure of institutional responsibilities". The authors discuss these findings and their implications.

This article is available to read in free full text at:  http://dx.doi.org/10.1080/14461242.2015.1006656

Lu, Y. & Racine, L. (2015). Reviewing Chinese immigrant women's health experiences in English-speaking Western Countries: A postcolonial feminist analysis. Health Sociology Review, 24(1), 15-28.

Studies in this issue (attached below):

"Findings include (i) the intersections of ethnicity and demographic variables such as age and gender highlight the different ways in which people interact, interpret and participate in adapted interventions; (ii) the representational elements of ethnicity such as ancestry or religion are more complexly lived than they are defined in adapted interventions and (iii) the contextual experiences surrounding ethnicity considerations shape the receptivity, durability and continuity of adapted interventions". The authors discuss the implications of these findings.

Now available in free full text at: http://dx.doi.org/10.1093/heapro/dau105 

Liu, J.J., et al. (2016). Adapting health promotion interventions for ethnic minority groups: A qualitative study. Health Promotion International, 31(2), 325-334.

In the latest issue (attached below): 

Studies reported in this issue (attached below):

In the latest issue (attached below): 

A population-based retrospective cohort study was performed, looking back 3 years from 31 December 2010, in urban primary care practices in Ontario, Canada. A total of 6303 physicians serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical screening, and 2,260,569 patients eligible for colorectal screening participated. Just fewer than 40% of physicians were female, and 26.1% were foreign trained.

In multivariable analyses, physicians who attended medical schools in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen their patients than Canadian graduates. South Asian-trained physicians were significantly less likely to screen South Asian women for cervical cancer than other foreign-trained physicians who were seeing region-congruent patient versus physicians from the USA, Australia and New Zealand). South Asian patients were the most vulnerable to under-screening, and decreasing patient income quintile was consistently associated with lower likelihood of screening, although less so for immigrant patients. 

The authors discuss the implications of these findings.

This is an open access article and is available to read in free full text at: http://dx.doi.org/10.1002/cam4.358

Lofters, A. K., Ng, R. and Lobb, R. (2015), Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada. Cancer Medicine, 4(2), 212–223

In the latest issue (attached below): 

We have now met with around fifty-five individuals across six different focus groups and the dialogue from these  is now beginning to shape our approach to diabetes support and services.

Below is a summary of each focus group discussion, outlining the flow of conversation, along with the key findings and some of the recommendations that emerged as a result.

We'll provide more information about the next steps from here shortly.

Thanks again to all those who were kind enough to share their stories and experiences with us, and also to the various health workers and local practices that helped co-ordinate the focus group invitations.

We look forward to keeping in touch.

Focus Group Summaries

Coastal Focus Group - discussion with participants living in a coastal region

Type 1 Young Adults Focus Group - discussion with a number of tertiary students living with Type 1 diabetes

Urban Focus Group - discussion with patients living in an urban city environment

Low Literacy, High-Needs focus group - participants from one of Wellington's lower income communities

Rural Focus Group - discussion with people from one of the more rural North Island towns

Indo-Asian Focus Group - participants from Auckland's Indian and South-East Asian communnities

This focus group was made up of 14 participants who all had Type 2 diabetes, with a number of the group having had the disease for over 20 years. All of the participants were of South Asian ethnicity and either in their later working years or their retirement.

The most common themes in this group included the lack of information appropriate to the Indian diet and exercise, the cultural barriers faced regarding accepting and managing their diabetes and the types of support received and services available in their area.

One participant described, “Even saying ‘Eat less carbohydrates’ means absolutely nothing to an 80 year old Indian woman. What are carbohydrates? Why not tell her to just eat half her roti instead?’”

Another member added, “The medical system here has no understanding of Indian culture at all. The advice they give just doesn’t work for us. It’s about acknowledging that we eat rice and japarti. Just being told ‘don’t’ doesn’t help. We need to be told what we can eat or how we can observe our traditions and culture in a healthy way.”

Indian cooking is also done collectively. “One downside of that is it feels like it’s too much trouble to cook something separate for yourself so you end up thinking ‘oh well, I’ll just have a little…,’” added another partipant.

Nutritional advice that has been specifically referenced in Indian culture would be very helpful. “We need to have advice about how to manage diabetes even though our culture eats rice. Something similar to the Ministry’s plate portions and other nutritional advice – how do you translate that into an Indian context?” asked one of the participants.

There were also cultural barriers including encouraging diabetics to exercise. Many Indians feel embarrassed to go to a gym or swimming pool. “Indian people are never going to go - we wear saris. There should be an exercise programme especially for Indian people.”

The change in culture from Indian to New Zealand is also a challenge. “Back home a lot of us came from farms so our exercise was a lot more regular. Here we just tend to stay in our homes. We don’t walk and our jobs aren’t active,” added another participant.

Other cultural barriers faced included the influence of family. “You can tell people anything they need to know but they will go home and do nothing if it means conflicting with their family. It is very much a collective decision, not an individual one. You need to reach the whole family.”

Another participant agreed, “Family plays a huge role in the life of the South Asian. It is a huge influence that can be both positive and negative.”

Some of the group also mentioned that because so many people have got diabetes it is almost normalised in their culture and viewed as inevitable. It becomes a barrier to prevention when people they think there is nothing they can do. It’s hard to even get them to try.

Some logistical barriers they faced were the availability of support services in their area. Diabetes NZ is based in Mt Eden and one of the participants said, “Indian people are not comfortable going there. It’s intimidating for us. If there was something more local or it was in Hindu or Punjabi, that would be better.”

Gaining access to services like the diabetes clinic was also a challenge depending on your health status. “Why is it that you have to wait until things get really bad before you can access the useful support?” asked one participant. “If we could get that earlier that would help prevent things better.”

One of the health workers who helped host the group, a nurse that worked in Greenlane, said, “I am the only Indian nurse available who speaks Hindi. Auckland DHB provides ethnic programmes but they need to be offered in other areas where there are high Indian populations. It should be standardised.”

Another participant added that they needed more help than just from their GP. “Just giving us medication and a prescription doesn’t help – they are not diabetes specialists. Plus there isn’t enough time to talk to them.”

Another participant added, “There are asthma nurses that see patients regularly on a one-to-one basis but there is nothing like that for diabetes.”

“When people are diagnosed with a chronic disease, their next appointment after the GP should be with a specialist for their condition. Chronic conditions need separate monitoring rather than just with the GP.”

One of the participants was himself a doctor and he admitted that he previously had poor notions of what a good diet was. “When I attended the programme run by a Diabetes Educator and Nutritionist who is also Indian, it made much more sense.”

Other cultural issues also come into play. “In our culture we put it on the doctor – we treat our doctors and priests like gods and put everything on them. But this is our diabetes! We need to take control.”

There is also a perception that insulin is very bad. “If you are on insulin, it is seen that your diabetes in deteriorating and you will die. There is also an anxiety about hypos – people fear dying in their sleep.”

Another participant added “People think once you are on insulin it becomes addictive and you are hooked like with morphine.”

The session was concluded with a discussion about some of the volunteer workers who give their time and support to the community for free. There are a number of very willing volunteers who just need some additional support. It was suggested this is something that could be utilised, supported and recognised much more actively.

Key recommendations based on this focus group include:

• Providing support services and education for patients and their families in Hindi or Punjabi
• Nutritional advice that has been specifically referenced in Indian culture for both health professionals and diabetics, especially with regard to their food
• Support to identify and implement ways to engage in physical activity that are appropriate to their culture in terms of dress code, environment, location, collective vs individual in nature etc.
• Support to change the misinterpretation of insulin
• Approaches to health information and advice that incorporate the entire family and address the perceived inevitability (and therefore apathy) towards diabetes

In the latest issue (attached below): 

Chinese women in New Zealand have low levels of awareness about the national breast screening programme and limited engagement with preventative primary care services, according to research published in the June edition of the Journal of Primary Health Care.

The study is one of the first attempts to identify factors affecting the understanding of, and access to, breast screening and breast cancer services by Chinese women. Breast cancer is the most prevalent female cancer in New Zealand and currently accounts for more than a quarter of all cancer diagnoses in women, and although Asian women in New Zealand have a lower rate of breast cancer registrations than the New Zealand population as a whole, they also have a lower uptake of mammography screening at 57 percent versus 69 percent.

The study found that while primary care providers are obvious sources of information about breast screening, not all migrant women are registered with a GP, and the preventive role of primary care providers is not well recognised.

Communication was repeatedly raised as the key issue when seeing a doctor in New Zealand, as was a limited understanding about Chinese perceptions of ill health and traditional Chinese medicine by New Zealand health professionals. A Chinese-speaking GP was preferred by most participants if available, not just for the language, but also for a ‘shared philosophy’ in relation to health.

The research has found that addressing communication barriers for Chinese migrant women has the potential to raise awareness about breast cancer and breast health, and to increase successful participation in breast cancer screening. The study recommends that health professionals working in primary and secondary care services make greater use of Chinese-language resources to assist migrant Chinese women to engage with and understand the role of primary care providers. The study also calls for a better understanding about Chinese perceptions of ill-heath, including complementary use of traditional Chinese medicine.

The research paper, called ‘Breast cancer and breast screening: perceptions of Chinese migrant women living in New Zealand’, has been published in the June issue of the Journal of Primary Health Care, which is on the Royal New Zealand College of General Practitioners’ website at: www.rnzcgp.org.nz/journal-of-primary-health-care.

• Asian health service development in Aotearoa
  
• Experience of life-limiting illness among South-Asian Sikhs and Muslims
  
• Advance care planning for Māori, Pacific and Asian people
  
• “Like Minds, Like Mine” anti-stigma and discrimination campaign
• Interpreter use in Canterbury general practice
  
• Deconstructing consumer choice in health communication
  
• Smokeless tobacco use in South-Asian Sydney
  
• Effective interventions in racism and health
  
• A social movement to transform institutional racism
• Health and wellbeing of secondary school students.

To subscribe to the Asian Health Research Review, go to: http://www.researchreview.co.nz/

Morning presentations were followed by discussion groups focusing on improving the capacity and effectiveness of the public health workforce in working with Asian families. The Agencies for Nutrition Action (ANA) has made the following presentations available at: http://ana.org.nz/event/2013-asian-forum/

• Plunket: Improving support to Asian Families. Early findings from a recent literature review and research into services for Asian families. Agnes Wong, Project Leader and Jess Beauchamp, Clinical Advisor, Plunket.
• Diabetes and breastfeeding. Eleanor Gates, Baby Friendly Hospitals Initiative Coordinator/Lactation Consultant, Waitemata DHB.
• Developmental Origins of Health & Disease: from evidence to workforce training, Gravida. New scientific research forming part of a new workforce education curriculum. Assoc Professor Mark Vickers, Principal Investigator Gravida.
• National Workforce Development Service. Jackie Gunn, Lead Curriculum Developer, Gravida.
• Counties Manakau Improving Nutrition Project. Pam Henry, Portfolio Manager Child Health and Maternity, CMDHB.
• Waitemata & Auckland Collective Project. Grant Berghan, Project  Manager, Waitemata DHB Maternal & Infant Nutrition & Physical Activity Collective.

In the latest issue (attached below): 

In the latest issue (attached below): 

All attendees reported positive experiences of the assessments and making lifestyle changes after the check, particularly to diet and exercise. The authors also consider advantages and disadvantages of these settings and how health checks in these settings might compare with general practice assessments.

To read the full abstract, and for information on how to access the full text, go to: http://fampra.oxfordjournals.org/content/30/4/466.abstract or contact your DHB library, or organisational or local library for assistance.

Eastwood, S.V., et al. (2013). Cardiovascular risk assessment of South Asian populations in religious and community settings: A qualitative study. Family Practice, 30(4), 466-472.

In the latest issue (attached below):

• Matariki 2013 Celebration hosted by Quitline
• Regular price rises doing trick but teamwork stubs habit
• A generation from now 2013
• Trans-Pacific Partnership Agreement public symposium
• Stress top factor in smoking relapses
• Encouraging Māori to join together to stop smoking on World Smokefree Day
• Students rally to help smokers
• Health Promotion Forum – Pacific provider/leaders fono
• Asian Health Promotion
• Jonathan Liberman presents ASPIRE2025 seminar
• Health Improvement & Innovation Resource Centre resources
• Recent research
• Smokefree shorts
• Quotable quotes

It is available to view at: http://www.sfc.org.nz/tcu/TCU223.html

Among their findings are that smokeless tobacco use is more prevalent among older participants who may have started chewing in India; although some younger English-born South Asians appear to be using smokeless tobacco. Reasons for chewing included moments of stress, boredom or simply to relax. Very few people were aware of the health risks. Many expressed a desire to quit, however found this difficult.

To view the full abstract and for information on how to access the full text, go to:
http://ntr.oxfordjournals.org/content/15/5/875.abstract or contact your DHB library, or organisational or local library for assistance.

Messina, J., et al. (2013). A systematic review of contextual factors relating to smokeless tobacco use among South Asian users in England. Nicotine & Tobacco Research, 15(5), 875-882.

In the latest issue (attached below):

This retrospective study evaluates the performance of the NHS Health Check diabetes filter in identifying people at risk for type 2 diabetes and concludes that the diabetes filter failed to identify a third of people at high risk of having or developing diabetes.

• Contraception in migrant Chinese women
• CVD risk in NZ Indians and Europeans
• Waitemata DHB cultural responsiveness
• NZ Chinese perception of colorectal cancer screening
• Racial discrimination and health
• Ethnic discrimination and health outcomes
• Racial discrimination in NZ
• Health needs assessment of Asian Aucklanders
• Evaluating the CALD Project 
• Interpreters in general practice
• Mental health awareness among Imams

To subscribe to the Asian Health Research Review, go to: http://www.researchreview.co.nz/

They identified high rates of diabetes among Pacific Islanders, South Asians, and Filipinos that were obscured by much lower rates among the large population of Chinese and several smaller Asian subgroups.

To read the full abstract, and for information on how to access the full text, go to: http://care.diabetesjournals.org/content/36/3/574 or contact your local, DHB or organisational library for assistance.

Karter, A.J., et al. (2013). Elevated rates of diabetes in Pacific Islanders and Asian subgroups: The Diabetes Study of Northern California (DISTANCE). Diabetes Care, 36(3), 574-579.

The analyses included 2,289 (72.1%) English-speaking and 885 (27.9%) Tamil- speaking Indians. Tamil-speaking Indians had significantly higher prevalence of T2DM and, among those with diabetes, higher prevalence of DR , vision-threatening DR, and visual impairment than English speaking Indians. Oaxaca decomposition analyses showed that the language-related discrepancies in T2DM, DR, and vision-threatening DR could not be fully explained by socioeconomic measures.

The authors conclude that, in an English dominant society, Tamil-speaking Indians are more likely to have T2DM and diabetic retinopathy. Social policies and health interventions that address language-related health disparities may help reduce the public health impact of T2DM in societies with heterogeneous populations.

This is an open access article and is available to read in full text at: http://www.biomedcentral.com/1471-2458/12/781/abstract

Zheng, Y., et al. (2012). Language barrier and its relationship to diabetes and diabetic retinopathy. BMC Public Health, 12:781.

• Minority research benefits the majority
• Refugee employment
• Refugee mental health…
• …best-practice models
• MELAA health needs
• Improving PHO enrolment
• Immigrant settlement experiences
• Ecological healing at Mangere
• RYAN programme
• Intimate partner violence…
• …and family violence is not ok

To subscribe to the Asian Health Research Review, go to: http://www.researchreview.co.nz/

Health issues related to changes in lifestyle are emerging with the long-term settlement of refugee communities. Reduced physical activity, diets high in fats and sugars and smoking place refugee groups, particularly those from South Asian, Middle Eastern and African groups, at risk of cardiovascular disease, obesity and diabetes. The inclusion of refugee groups and their ethnic communities in mainstream prevention, screening and intervention services and programmes is of importance in maintaining good health outcomes for settled communities.

To download the handbook, or for information on ordering copies, go to: http://www.health.govt.nz/publication/refugee-health-care-handbook-health-professionals

This New Zealand Society for the Study of Diabetes (NZSSD) 2011 statement is a guide for health practitioners and complements 2003 and 2009 formal guidelines produced by the New Zealand Guidelines Group.

A new public awareness campaign, Your Local Doctor, hopes to address lower than average enrolment rates among people of Asian descent in Auckland. Waitemata District Health Board epidemiologist Dr Lifeng Zhou says studies have consistently shown that people with an ongoing relationship with their GP tend to get diagnosed more quickly, and spend less time in hospital.

“It’s about keeping people healthy and well. When you have a doctor you trust and see regularly, not only does it ensure that you get the right treatment when you are unwell, but your doctor will have a good idea of your overall health, lifestyle and risk factors to watch out for, such as conditions like heart disease that may run in your family.”

To read the full press release from the Waitemata District Health Board at Scoop, go to: http://www.scoop.co.nz/stories/GE1203/S00064/encouraging-gp-enrolment-among-aucklands-asian-communities.htm

They report that one-third of those patients had "... painful neuropathy symptoms, regardless of their neuropathic deficit. PDN was more prevalent in patients with type 2 diabetes, women, and people of South Asian origin. This highlights a significant morbidity due to painful neuropathy and identifies key groups who warrant screening for PDN".

Abbott, C., et al. (2011). Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care, 34(10). 2220-2224

This article is available to read free in full text at: http://care.diabetesjournals.org/content/34/10/2220.full

The first time many patients realise diabetes can affect their kidneys is when they are referred to renal services, according to a UK multi-cultural study, reported in the Journal of Renal Care. 

Researchers interviewed 48 white and South Asian patients with diabetes attending specialist renal services in Leicester, Luton and Ealing.

Wilkinson E., Randhawa G., Farrington K., Greenwood R., Feehally J., Choi P., Lightstone L., (2011). Lack of awareness of kidney complications despite familiarity with diabetes: a multi-ethnic qualitative study. Journal of Renal Care 37(1), 2-11.

The abstract and fulltext of this article are available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1755-6686.2011.00199.x/abstract