D9 1 an interprofessional approach to chronic disease self management among immigrants and refugees

CHRONIC DISEASE SELFMANAGEMENT AMONG IMMIGRANTS AND REFUGEES Rosalinda Chen1, AKM Alamgir2, Nicole Nitti2 1. University of Toronto 2. Access Alliance Multicultural Health and Community Services

Presenter Disclosure Presenters: Rosalinda Chen, Dr. Nicole Nitti Relationships to commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

Disclosure of Commercial Support This program has received financial support from [none] in the form of [n/a]

This program has received in-kind support from Access Alliance Multicultural Health and Community Services in the form of research and logistical support.

Potential for conflict(s) of interest: N/A

Mitigating Potential Bias

N/A

Background

Background

Newcomers

Chronically Ill

Self-Management Barriers

Explore barriers to self-management experienced by Access Alliance primary care clients, and develop agencylevel recommendations for self-management support

Methods In-Depth Interviews ■ Access Alliance Clinicians and Staff – n=10 – Thematic Analysis

Methods Systematic Literature Review ■ Participant and study characteristics – Hispanic > African Americans > East Asians – Type 2 Diabetes Mellitus – Study Location: USA, UK, Canada

BARRIERS TO SELFMANAGEMENT

1) Social Isolation “A state where people are deprived of the support provided by other individuals�

(Berg et al., 1990)

Social Isolation Low motivation Other priorities Baumann et al., 2012 Nam et al., 2011 Jerant et al., 2005

Reduced disease selfmanagement

2) Health Literacy “The degree to which individuals have the capacity to obtain, process and understand health information needed to make health decisions.�

(Institute of Medicine)

English Language Illiteracy Low Health Knowledge Shaw et al., 2012 Williams et al., 1998 Nam et al., 2011

Low Health Literacy

Reduced SelfManagement

3) Socioeconomic Status “Social

standing or class of individual…often measured as combination of education, income, and occupation” (American Psychological Association)

Low Income Employment

Baumann et al., 2012 Nam et al., 2011

Reduced SelfManagement

4) Mental Health

Depression Post-Traumatic Stress Disorder

McKenzie et al., 2009 Anderson et al., 2015

Reduced SelfManagement

CURRENT STRATEGIES

Current Strategies

PROPOSED SOLUTIONS

1) Group Support Program

In The Literature‌ Gregg et al., 2007

Group interventions reduce social isolation

Rosal et al., 2011

Gucciardi et al., 2013

Self-management interventions delivered in group settings have behavioral and clinical benefits

2) Peer Support Interpretation System Navigation Accompaniment

In The Literature…

Creamer et al., 2015

Cabello et al., 2014

Gucciardi et al., 2012

Interventions delivered by peers are significantly associated with behavioral benefits and clinical improvements ■ Participants may associated peers with increased credibility ■ Peers can provide culturally tailored support

Ferguson et al., 2015

3) Comprehensive Individual Counselling

4) Mental Health Support

5) Provider Support

Awareness of Resources

Training

Administration Support

Sharing Strategies

In The Literature‌

Limited evidence that achieved HbA1c reductions were sustained 12 months post-intervention

Tackling underlying barriers beyond disease-specific selfmanagement behaviors required to achieve long-term benefits

Limitations ■ Study mainly involved perspectives of AA clinicians, rather than patients themselves ■ A minority of patient interactions may be overrepresented in provider perceptions ■ However, study can guide future investigations

Conclusions Interdisciplinary, comprehensive approach to self-management support is needed to achieve long-term health benefits

Next Steps Gain Client Perspective Needs Assessment

Questions?

Discussion – Break-Out Sessions Group 1 - Peers

• What chronic disease self-management strategies have been present in agencies that you have worked in? Successes?

Limitations?

• Do you think the use of peers are effective in supporting selfmanagement? Current practice strategies?

• If you had a genie, what would your 3 wishes be with respect to implementing peer support? Which of those wishes could be implemented in the next 1-2 years?

Discussion – Break-Out Sessions Group 2 – Mental Health Support • Do you think that mental health support is effective in supporting self-management? Current practice strategies?

• If you had a genie, what would your 3 wishes be with respect to implementing mental health support? Which of those wishes could be implemented in the next 1-2 years?

• Do you think that supporting the underlying barriers to selfmanagement beyond disease education (such as mental health challenges or social barriers) is feasible for an individual agency?

Discussion – Break-Out Sessions Group 3 –Provider Support • What chronic disease self-management strategies have been present in agencies that you have worked in? Successes?

Limitations?

• Do you think that enhancing provider support is effective in supporting self-management? Suggested practice strategies?

• If you had a genie, what would your 3 wishes be with respect to enhancing provider support? Which of those wishes could be implemented in the next 1-2 years?