Toward the Goal of Understanding and Tackling the Social Determinants of Diabetes.

Diabetes cannot be understood purely by research into biological and lifestyle factors. Significant social determinants of health (SDOH), such as income, employment and housing, play a critical role yet remain under-studied. Indigenous, racialized, LGBTQ2S+ and low-income communities are disproportionately impacted by diabetes. These inequalities are shaped by the distribution of money, power and resources, and were propelled to the fore during the COVID-19 pandemic. Understanding and mitigating the impact of social determinants of diabetes are urgent priorities given the prevalence and economic cost of the disease. This special issue, the first of its kind for the Canadian Journal of Diabetes, brings together multifaceted research on the profound social determinants that affect people living with type 1 and type 2 diabetes. This is a crucial step toward understanding and tackling disparities in diabetes research, care and policy.</p

Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study

BackgroundProstate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors’ care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. ObjectiveThis study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. MethodsAn axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. ResultsUnmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as “eating bitterness,” and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as “better than nothing;” it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants’ desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. ConclusionsChinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing “trickle-up” adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions

Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: A qualitative study

Purpose: South Asians experience high rates of cardiovascular disease yet participate in cardiac rehabilitation (CR) at low rates. Drawing on the PRECEDE model, the purpose of this qualitative descriptive study was to identify the cultural factors facilitating South Asians' participation in CR programs. Methods: Two semi-structured interviews were conducted with each of 16 Canadian South Asian participants enrolled in a 12-month CR program. Transcribed data was analyzed for common themes and categorized in terms of predisposing, enabling, and reinforcing factors. Results: Primary cultural facilitators included CR being described as a “medically-supervised” program, family and physician support, and having prior knowledge of CR from members of the South Asian community. Conclusion: Previous research has identified barriers to CR participation in the South Asian community, and this is the first to identify facilitators. Cultural factors identified as facilitating participation should be considered when developing future initiatives to engage this population group in CR