Assessment and outreach regarding diabetes among the Cambodian, Hmong, Lao and Khmu communities

Diabetes is rampant among the Cambodian, Hmong, Lao and Khmu communities, particularly among those with low social economic status and those who are limited English proficient. Not only diabetes rapidly increasing, Southeast Asians suffer more from diabetic complications such as heart disease, kidney failure, amputation, vision loss, and premature death. Cambodian, Hmong, Lao and Khmu community organizations have declared diabetes a health crisis calling for urgent action to address the profound quality of life inequities that arise from diabetes when the disease is inadequately managed. To understand the extent of health inequities related to diabetes, we conducted focus groups and community surveys to determine the community's experience with healthcare related to diagnosis and management of diabetes. In addition we interviewed shaman, herbalists, and Western primary healthcare providers utilized by the Hmong community. Our study was framed by the social determinants of health model. We found several sociocultural barriers such as lack of accurate knowledge about the causes and treatment of diabetes, fear of finding out they are sick and fatalism, exclusive use of lay herbalists, lack of trust in Western healthcare and preferred cultural food intake and life styles that conflict with recommended diabetic care management. Community-level structural barriers included attitudes and practices of healthcare providers such as lack of adequate time during healthcare visits to fully discuss treatment options, complexity of treating multiply health conditions, and polypharmacology. Using results from our study we conducted a diabetes community outreach project that included a partnership with our local public radio station.