1. Ann Mitchell What does Type 2 diabetes mean for Guyanese women living in the UK

2. Guyana on north east coast of South America 83,000 square miles Population <1 million Highly complex ethnic group with a great diversity of beliefs 90% Asian and African

3. Who are Guyanese people?

4. Migration to England Political crisis in Guyana during 1960’s and 70’s Severe shortage of nurses (Behishon et al 1995 For academic study

5. Aims of study To explore how Guyanese women who migrated to UK, make sense of, experience and manage Type 2 diabetes To assist health care practitioners and policy makers to deliver appropriate diabetic services to these women

6. Rationale for study Type 2 diabetes is a long term condition with serious negative consequences People from South Asian descent and African Caribbean ethnic groups are particularly at risk (DH 2007) By focusing on a specific minority population (Guyanese), rich insightful data can be obtained which have the potential to provide insight into the needs of a broader ethnic population

7. Justification for study This study looks to develop a rich insight into the perspectives of Guyanese migrant women who have been diagnosed with type 2 diabetes Aim is to obtaining more valid and better informed insights into their values, thoughts, feelings and behaviours related to their diabetes management

8. …by asking the key questions: Do cultural beliefs and standpoints influence their diabetes management behaviour? Do their spiritual assumptions influence their health seeking behaviour? Are there any social pressures that influence their help- seeking behaviour?

9. Background to study Type 2 diabetes has a long- and well-established literature both generally and in terms of specific minority groups Management by conventional medicine involves compliance with prescribed medication and lifestyle change Health beliefs and diverse influences arising from biomedicine and complementary and alternative medicine may dictate whether individuals seek help or not.

10. Different discourses framing Type 2 diabetes Biomedical model Alternative health systems – such as Ayurvedic or Chinese Traditional Medicines Complementary therapies – such as herbalism Cultural challenges – such as a traditional diet, HIV- AIDS Spiritual beliefs, such as in obeah

11. Methodology - Social constructionist approach Qualitative study that looks to the meaning of experiences and accepts multiple knowledges Small purposeful sample Research methods: focus groups biographical narrative interviews diaries Analysis – grounded theory approach

12. Preliminary Findings The biomedical model is the commonly preferred choice of treatment in these populations However sometimes a combination of complementary and alternative medicine chosen Ethnic minority women are held to have an ‘inadequate knowledge’ of this condition Cultural standpoint can influence diabetes management Spiritual beliefs can also influence management

13. Conclusions Guyanese women are under-researched – there is a need to capture their lost voices rather than treating them as one homogenous group Guyanese migrant women are an ageing population and so may require specific health care services Cultural and spiritual standpoints are important when services are provided for these women to help them manage their diabetes

14. References Anderson R M and Funnell M M (2000) Compliance and Adherence are Dysfunctional concepts in Diabetes care. The Diabetes Educator. 26. No 44. p.597 – 604. Awah P H, Unwin N and Phillimore P (2008) Cure or control; complying with biomedical regime of diabetes in Cameroon. BMC Health Services Research. 8:43. p.1-11. BMA (2004) Diabetes Mellitus – An update for Health Care Professionals. BMA publication unit. Chacko E (2003) Culture and therapy: complementary strategies for treatment of Type 2 diabetes in urban setting in Kerala, India. Social Science and Medicine. 56, p.1087- 1098. Department of Health (2007) Working together for better diabetes care. London: DH Finlay L (2006) Qualitative Research for Allied Health Professionals.Ed. Chichester: John Wiley