When 14-year old Kiran Grewal joined the South Asian Adolescent Diabetes Awareness Program (SAADAP), she did it because diabetes runs in her family. Her father, her aunt (on her dad’s side) and both of her grandmothers have type 2 diabetes (T2DM), and her little brother was recently diagnosed with pre-diabetes. “I chose to be part of this program because diabetes runs in the genes of my family,” she says. “I wanted to learn more about diabetes and what I could do to prevent myself from being diagnosed with it.”
Kiran’s experience is one that is familiar to many South Asian youth, who face a disproportionately higher risk of diabetes than their Caucasian counterparts in Canada. As one of 80 participants in SAADAP, a two-year research and engagement project funded by the Lawson Foundation, Kiran attended a series of group sessions with other South Asian youth, in addition to receiving one-on-one coaching and support from a dietician and a kinesiologist who helped her to make healthy food and active lifestyle choices to mitigate her risk of diabetes.
Dr. Ananya Tina Banerjee, a researcher at the University of Toronto and the project’s principal investigator, saw firsthand the impact of this project and the value of engaging youth in developing and maintaining healthy lifestyle habits for themselves. The Lawson Foundation sat down with Ananya to learn more about the project and what she believes are the key lessons learned so far…
What drew you to this work?
There’s definitely a personal connection for me to this work. My dad has diabetes and my mom has also been diagnosed with pre-diabetes. While I studied kinesiology, I learned more about the importance of physical activity and making healthy food choices, which I shared with my parents and also adopted myself – knowing that I was also at a greater risk of being diagnosed with diabetes myself.
Can you tell us more about the reason for the project’s focus on the South Asian community?
Yes, absolutely. South Asian diaspora communities in Ontario face disproportionately high rates of T2DM (15.9%) as compared to their Caucasian counterparts (11.6%). The elevated rates are of concern because morbidity associated with T2DM includes heart disease and kidney disease, that dramatically impact quality of life and increase interactions with healthcare services ultimately, shortening life expectancy and increasing risk of mortality. Our goal is to break the cycle of family history of T2DM.
What are some of the factors that contribute to these higher rates?
While genetics and individual lifestyle choices certainly play a role, we know that there are a number of social factors that contribute to elevated rates of T2DM. Food insecurity, precarious employment, access to healthcare and even the neighbourhood we live in can all contribute to elevated risks of being diagnosed with T2DM. We also know that racialized communities – including the South Asian community tend to be affected by these risk factors at higher rates than their Caucasian counterparts.
How might these social risk factors impact the South Asian community specifically?
A lot of it comes down to settlement and immigration patterns. Often, resettlement occurs in areas where traditions and cultural practices endure creating ethnic enclaves, which can limit access to culturally safe services. We know that culturally-tailored programs are vital to engage communities and support preventative practices to reduce the risk of chronic disease like T2DM.
South Asians are also more likely to experience food insecurity and live in neighbourhoods with poor built environments. They are more likely living in low-income households and being in precarious work situations. The reality is little attention is given to the role of social issues in understanding diabetes in South Asian communities. It is puzzling why social factors causing diabetes in racialized communities such as poverty are not being acknowledged by health policies.
So how might that affect how health professionals engage with this community?
For these reasons, it’s important to look at these social contexts and how they might influence health behaviour. Simply telling South Asian patients to exercise and eat healthy is problematic when they have competing priorities such as being financially stable and secured. Health care professionals need to go deeper and ask questions like do you have access to gym or fitness classes? Is your neighbourhood conducive to walking? What is your work schedule like? Do you have health benefits? Can you afford to manage diabetes?
This project has taken a proactive approach in engaging South Asian youth who are at higher risk of diabetes. What has been the result so far?
We’ve been actively engaging with South Asian youth to tailor a program that meets and adapts to their individual needs and realities, raising their awareness on the social issues in developing diabetes. This has led to critical conversations for youth in the program to identify health related school policies – including lack of positive role modelling, access to healthy food and choices and fitness programs which we were able to work with and build in our intervention. Participants have reported increases in their physical activity and healthy eating since the inception of our program. Further, they want to be peer-educators and scale SAADAP across the Greater Toronto Area.
What’s next for the project?
While the group and individual sessions for participants are completed, we’re still working with a sub-group of the participants to better understand the perceptions of developing T2DM in South Asian adolescents. More specifically, we’ll be using a participatory action research strategy to gather insights directly from youth. Called Photovoice, participants will take photos of what prevention of T2DM means to them over a one-week period. We’ll then host focus groups to discuss their pictures to record and vivify the community’s strengths and concerns, promote critical dialogue and knowledge about SA community health issues related to T2DM, and reach and to inform policy makers.
As for Kiran, the impact of the program has been profoundly important. “I learned very useful information about diabetes – which will stay with me.”
Please stay tuned as CBC will follow up on the story once the SAADAP publishes its results.
The Lawson Foundation Guest Blog Series
The Lawson Foundation is pleased to share updates from our grantees through this guest blog series. It provides an opportunity for our grantees to share stories from the field, lessons learned, as well as put forward thought provoking policy ideas.