Aboriginal men more likely to avoid diabetes clinics, says researcher

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Fred Wien said aboriginal people especially men feel alienated by the health-care system.

His presentation Monday at the University of Regina was part of the Aboriginal Health Research Networks Conference. It was based on a project Wien is involved in, Talking With Their Feet, about why so many aboriginal people in Atlantic Canada choose not to use diabetes clinics.

The project idea was sparked by the 2003 Nova Scotia regional health survey, which found that 19 per cent of aboriginal men had diabetes, 52 per cent of whom did not attend diabetes clinics. More than half of the non-attenders cited choice.

In women, the incidence of diabetes was about the same, but 75 per cent used the clinics. This led Wien’s team to find out why so many people choose not to use the clinics, which are designed to help them.

Wien said this survey’s findings reflected previous research, including a study on aboriginal cancer care he once did.

“I will always remember what they told us about how foreign and unfriendly they felt the service environment was that they had to navigate through, and how vulnerable they were to simple things like getting transportation from the reserve community to an urban health centre for appointments with medical personnel,” said Wien, of the Atlantic Aboriginal Health Research Program and Dalhousie University.

Wien said the diabetes research, which included interviews with 42 patients and caregivers in the Atlantic region, also showed that denial and shame for being diagnosed played a part in seeking medical help. Other reasons were that patients could get advice from community members, and they had bigger things to worry about than diabetes, like raising a family.

Wien said they also didn’t want doctors and nutritionists preaching about eating poorly and not exercising.

“I think that kind of recommendation comes forward without understanding the whole context that the person is in,” said Wien, adding, “I’ve always had the point of view that you can’t successfully address social and health issues without also addressing the economic side. If people don’t have jobs, they don’t have anything to do, they don’t have much money, then that impacts a whole range of things from health behaviours to not being able to afford nutritious food to having less success in the educational system, and so on.”

Patients said clinics are daunting because of language and cultural barrier, and that they want to develop a relationship with medical staff, which Wien said is difficult because doctors are so busy and there can be high staff turnover.

For all of these reasons, Wien said patients should not be blamed.

“At these treatment facilities, there’s a tendency to kind of blame the patient for not showing up, and even after two or three missed appointments, they essentially write that person off their list as being unreliable and untrustworthy,” he said.

Wien said his findings could be built into the next regional health survey, including “how many people are affected by transportation difficulty, (and) not being able to afford diet. Each kind of study contributes a piece.”

Though the research covered only a small amount of the population, Wien said, “We’re not making any claims that the people we spoke to are representative of a wider population. It’s a group of people who agreed to participate. We tried to develop an in-depth understanding of a situation, but we’re not saying that these results can be generalized to all people who don’t attend diabetes clinics.”

The three-year study was led by Barbara Paterson, now the dean of nursing at Thompson Rivers University in B.C., and was funded by the Canadian Institutes of Health Research. It is slated to be completed in September.

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