Lisa Hanna

‘We should change ourselves, but we can't’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts. Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones. Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be ‘dangerous’ and detrimental to their diabetes control. Respondents described such foods as ‘strength-giving’, and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines. Conclusions. Perceptions that South Asian foodstuffs necessarily comprise ‘risky’ options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.

Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Aims  To explore Pakistani and Indian patients’ experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.

Cross-cultural adaptation of a tobacco questionnaire for Punjabi, Cantonese, Urdu and Sylheti speakers: qualitative research for better clinical practice, cessation services and research

Objective: To develop cross-culturally valid and comparable questionnaires for use in clinical practice, tobacco cessation services and multiethnic surveys on tobacco use. Methods: Key questions in Urdu, Cantonese, Punjabi and Sylheti on tobacco use were compiled from the best existing surveys. Additional items were translated by bilingual coworkers. In one-to-one and group consultations, lay members of the Pakistani, Chinese, Indian Sikh and Bangladeshi communities assessed the appropriateness of questions. Questionnaires were developed and field tested. Cross-cultural comparability was judged in a discussion between the researchers and coworkers, and questionnaires were finalised. Questionnaires in Cantonese (written and verbal forms differ) and Sylheti (no script in contemporary use) were written as spoken to avoid spot translations by interviewers. Results: The Chinese did not use bidis, hookahs or smokeless tobacco, so these topics were excluded for them. It was unacceptable for Punjabi Sikhs to use tobacco. For the Urdu speakers and Sylheti speakers there was no outright taboo, particularly for men, but it was not encouraged. Use of paan was common among women and men. Many changes to existing questions were necessary to enhance cultural and linguistic appropriateness—for example, using less formal language, or rephrasing to clarify meaning. Questions were modified to ensure comparability across languages, including English. Conclusion: Using theoretically recommended approaches, a tobacco-related questionnaire with face and content validity was constructed for Urdu, Punjabi, Cantonese and Sylheti speakers, paving the way for practitioners to collect more valid data to underpin services, for sounder research and ultimately better tobacco control. The methods and lessons are applicable internationally.

Incorporating sustainability into community-based healthcare practice.

There is now irrefutable evidence that climate change and increasing environmental degradation negatively affect population health. Healthcare plays an important role in addressing these emerging environmental challenges, considering its core aim is to protect and promote health. Preliminary research in Victoria, Australia, suggests that healthcare practitioners are endeavouring to factor in environmental concerns into their practice. Health promotion, an integral part of the healthcare system, is considered an area of practice that can support action on sustainability. Based on five qualitative case studies and key stakeholder interviews, this article explores key barriers and facilitators to incorporating sustainability into community-based healthcare practice. The findings demonstrate that despite multiple barriers, including funding and lack of policy direction, health promotion principles and practices can enable action on sustainability.

Practising social inclusion

Part 1: Introduction 1. Scoping Social Inclusion Practice Ann Taket, Beth R. Crisp, Melissa Graham, Lisa Hanna and Sophie Goldingay Part 2: Practising Inclusion in Policy 2. Conscience Clauses: Your Right to a Conscience Ends at my Right to Safe, Legal and Effective Health Care Sarah Barter-Godfrey and Julia Shelley 3. Practising Inclusion in Policy Design for People with Disabilities Natasha Layton and Erin Wilson 4. Practising Social Inclusion Through Regulation: Occupational Health and Safety for Commercial Sex Workers Beth R. Crisp and Michael W. Ross Part 3: Practising Inclusion in Service Design 5. Inclusive Service Development: Exploring a Whole of Organisation Approach in the Community Service Sector Sarah Pollock and Ann Taket 6. Increasing Social Cohesiveness in a School Environment Karen Stagnitti, Mary Frawley, Brian Lynch and Peter Fahey 7. Inclusive Service Design for Young People with Learning Disabilities Who Exhibit Behaviours of Concern Sophie Goldingay and Karen Stagnitti Part 4: Practising Inclusion in Service Delivery 8. Working for Connection and Inclusion: The Role of Front Line Practitioners in Strengthening the Relational Base of Marginalized Clients Mark Furlong 9. Experiments in Social Inclusion and Connection: Cases From Lebanon Jihad Makhoul, Tamar Kabakian-Khasholian, Michael El-Khoury and Faysal El-Kak 10. Practising Social Inclusion: The Case of Street-Based Sex Workers and the St. Kilda Gatehouse in Melbourne Rachel Lennon, Pranee Liamputtong and Elizabeth Hoban Part 5: Practising Inclusion in Community Life 11. Promoting Social Inclusion of Frail Older People Living in the Community Ann Taket, Sarah Pollock, Lisa Hanna, Emily Learmonth and Peta Farquhar 12. Enabling New Students to Feel That They Matter: Promoting Social Inclusion Within the University Community Beth R. Crisp and John Fox 13. Community-Driven Social Inclusion Practice: A Case Study of a Multicultural Womens Friendship Group Lisa Hanna and Jan Moore 14. Practicing Social Inclusion: Comfort Zone - A Social Support Group for Teenagers with High Functioning Autism Jessica Gill, Pranee Liamputtong and Elizabeth Hoban Part 6: Practising Inclusion in Research 15. Preventing HIV Through Social Inclusion Using Community Based Participatory Research Suzanne M. Dolwick Grieb, Ndidiamaka Amutah, Jason Stowers, Horace Smith, Kimberli Hammonds and Scott D. Rhodes 16. Inclusive Research with People with Intellectual Disability: Recognising the Value of Social Relationships as a Process of Inclusive Research Erin Wilson and Robert Campain 17. Examining the Notion of Informed Consent and Lessons Learned for Increasing Inclusion Among Marginalised Research Groups Nena Foster and Emily Freeman 18. The Invisibility of Childlessness in Research: A More Inclusive Approach Melissa Graham 19. Inclusion in Participatory Research - What Were the Whitefellas Doing in an Aboriginal Health Project? Sarah Barter-Godfrey, Sarah Pollock and Ann Taket Part 7: Conclusion 20. Implementing the Social Inclusion Agenda Beth R. Crisp, Ann Taket, Melissa Graham and Lisa Hanna

Playing Active Video Games may not develop movement skills: An intervention trial.

Background: To investigate the impact of playing sports Active Video Games on childrens actual and perceived object control skills. Methods: Intervention children played Active Video Games for 6 weeks (1 h/week) in 2012. The Test of Gross Motor Development-2 assessed object control skill. The Pictorial Scale of Perceived Movement Skill Competence assessed perceived object control skill. Repeated measurements of object control and perceived object control were analysed for the whole sample, using linear mixed models, which included fixed effects for group (intervention or control) and time (pre and post) and their interaction. The first model adjusted for sex only and the second model also adjusted for age, and prior ball sports experience (yes/no). Seven mixed-gender focus discussions were conducted with intervention children after programme completion. Results: Ninety-five Australian children (55% girls; 43% intervention group) aged 4 to 8 years (M 6.2, SD 0.95) participated. Object control skill improved over time (p = 0.006) but there was no significant difference (p = 0.913) between groups in improvement (predicted means: control 31.80 to 33.53, SED = 0.748; intervention 30.33 to 31.83, SED = 0.835). A similar result held for the second model. Similarly the intervention did not change perceived object control in Model 1 (predicted means: control: 19.08 to 18.68, SED = 0.362; intervention 18.67 to 18.88, SED = 0.406) or Model 2. Children found the intervention enjoyable, but most did not perceive direct equivalence between Active Video Games and ‘real life’ activities. Conclusions: Whilst Active Video Game play may help introduce children to sport, this amount of time playing is unlikely to build skill.

Parents' and children's views on whether active video games are a substitute for the 'real thing'.

Background: Research has examined the energy cost associated with playing seated and active video games (AVGs), but not whether AVGs may benefit fundamental movement skills (FMS) in typically developing children. Improving FMS proficiency is a priority given its association with physical activity. This study aimed to identify children’s and parents’ perceptions of: (1) AVGs as a tool for developing FMS and (2) whether any skills gained during AVG play had potential to transfer to real life. Methods: This qualitative descriptive study included 29 parents of children aged 9–10 years who participated in semi-structured telephone interviews and 34 children who participated in six group discussions at school. Interview and discussion group data were recorded, transcribed and analysed thematically. Results: Parents and children had different perspectives on the potential of AVGs for FMS, which largely rested on different views of ‘reality’. Parents felt AVGs were not a substitute for the ‘real thing’, and therefore had limited FMS benefits. Overall, parents thought any FMS gained through AVGs would have poor transferability to ‘real life’. In contrast, children had a more fluid and expansive view of reality which incorporated both ‘real life’ and ‘virtual’ space. Whilst children could articulate limitations of AVGs for skill learning, they still reported extensive use of AVGs as a learning tool for movement skill, and considered that skill acquisition was highly transferable. Conclusions: Despite contrasting beliefs from parents and children, children used AVGs for FMS learning. Future research needs to determine whether actual FMS benefits are gained through AVGs.

Using the Rose Angina Questionnaire cross-culturally: the importance of consulting lay people when translating epidemiological questionnaires

Objectives. The Rose Angina Questionnaire (RAQ) is an important measure of coronary heart disease prevalence. It has been shown to perform inconsistently across some ethnic groups in Britain. This study investigates whether the best available versions of the RAQ in Punjabi and Cantonese were linguistically equivalent to the English version. Design. Interviews were carried out with lay people from the Pakistani, Chinese and European-origin communities in Scotland to assess the versions of the RAQ used in the Newcastle Heart Project (the best available versions). For each questionnaire item, participants were asked to elaborate on their understanding of the question and the meaning of keywords or phrases. Results. Problems were discovered with the Punjabi and Cantonese translations of the RAQ. For example, the translation for ‘chest’ was interpreted by some Pakistani and Chinese women to mean ‘breasts’. ‘Walking uphill’ was translated in Chinese as ‘walking the hill’, without stipulation of the direction, so that some Cantonese speakers interpreted the question as pertaining to walking downhill. Many Chinese interpreted RAQ items to be referring to breathlessness rather than chest pain due to ambiguous wording. Conclusion. Existing versions of the RAQ are unlikely to be yielding data that are cross-culturally valid or comparable. For robust health survey research in languages other than that in which the questionnaire was developed, lay assessment of questionnaires prior to and after translation is a necessity rather than a luxury.

Service providers' experiences and needs in working with refugees in the Geelong region: a qualitative study.

Service providers in Geelong, one of the priority locations for the resettlement of refugees in regional Australia, were interviewed to explore their perceptions of the health and wellbeing needs of refugees, and the capacity of service providers in a regional area to meet these. In all, 22 interviews were conducted with health and human service professionals in a range of organisations offering refugee-specific services, culturally and linguistically diverse (CALD) services in general, and services to the wider community, including refugees. The findings revealed that a more coordinated approach would increase the effectiveness of existing services; however, the various needs of refugees were more than could be met by organisations in the region at current resource levels. More staff and interpreting services were required, as well as professional development for staff who have had limited experience in working with refugees. It should not be assumed that service needs for refugees resettled in regional Australia will be the same as those of refugees resettled in capital cities. Some services provided in Melbourne were not available in Geelong, and there were services not currently provided to refugees that may be critical in facilitating resettlement in regional and rural Australia.

Ways in which ‘community’ benefits frail older women's well‐being: ‘we are much happier when we feel we belong’

Aim:  This paper aims to explore frail older womens lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well‐being.