Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Diabetes narratives in migrants: How careful analysis of stories can help us rise above the ontological desert of ‘behaviour change’ research (#80)

Trisha Greenhalgh 1
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom

Type 2 diabetes is to a large extent, a ‘lifestyle disease’. Lifestyle choices are shaped by cultural contexts, which are currently under-researched.  

Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds. It leads to short-term morbidity and longer-term metabolic programming in mother and offspring. This lecture will describe a study that aimed to capture the cultural contexts of health-related behaviour of South Asian women. 

45 women were recruited from diabetes and antenatal services in two deprived London boroughs. They shared their experiences of diabetes, pregnancy and health services in group discussions or individual interviews. Narrative analysis used Glass and McAttee’s ‘axis of nested hierarchies'. 

Key storylines recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother’s strength, and that eating would be strength-giving for mother and fetus. Medium-term storylines depicted family life, especially the cultural, practical and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare. Longer-term storylines addressed genetic, cultural and material heritage – including migration, acculturation and family memories of food insecurity. While peer advice was familiar, meaningful and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning.

‘Behaviour change’ interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural ‘choices’ are made.