Mubarak Ismail

Stress and Type 2 Diabetes: A Review of How Stress Contributes to the Development of Type 2 Diabetes

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK

AIM To explore experiences of the diagnosis and management of tuberculosis from the perspective of Somali patients and healthcare professionals involved in their care. BACKGROUND The Somali population has the third highest incidence of tuberculosis occurring in persons born outside the UK. Tuberculosis is a disease with sociocultural as well as physical consequences. Nurses should understand how the disease is experienced by people from different ethnic backgrounds to implement strategies for prevention and management of tuberculosis. DESIGN A focused ethnography. METHOD Individual interviews with 14 Somali patients and 18 healthcare professionals with experience of providing care to Somalis were undertaken in 2008-2009. Interviews explored the patient experience from onset of symptoms to completion of treatment. Data were analysed using Framework approach. FINDINGS Despite presenting in primary care early, patients experienced diagnostic delays due to low clinical suspicion of tuberculosis among general practitioners. Although patients reported felt and enacted stigma, it did not adversely affect concordance with treatment. Patients were reticent about sharing their diagnosis among wider networks due to perceived stigma. Psychological support from families and specialist nurses was valued highly. Healthcare professionals perceived that stigmatization of tuberculosis was diminishing among Somalis leading to improved management of tuberculosis. Patients and healthcare professionals raised concerns about the longer term physical and psychosocial implications of tuberculosis once treatment was completed. CONCLUSION Nurses have a role in promoting early presentation, timely diagnosis, and treatment adherence through supporting Somali patients and raising awareness of the disease among primary care practitioners.

Engaging minorities in researching sensitive health topics by using a participatory approach

AIM To report the use of a community participatory approach (PA) in a project investigating tuberculosis (TB) in UK Somali migrants. BACKGROUND It is crucial to address health inequalities and persistent health problems, particularly in groups who are often excluded or seem hard to reach. TB is an illness stigmatised in the Somali population, making it a difficult topic for research. In this study, a community PA was used to investigate TB and members of the Somali community were recruited as co-researchers. DATA SOURCES Four community researchers (CRs), eight focus groups (n=48), interviews with members of the community (n=24), people with TB and ex-TB patients (n=14), and healthcare practitioners (n=18). REVIEW METHODS This is an informative paper. Discussion The paper describes the approach used in the recruitment of community researchers and how engaging early with community leaders using oral communication made it possible to research TB in the Somali community. CONCLUSION The PA led to capacity building, trust and a longer sustainable partnership with members of the Somali community. The success of the approach in the study suggests that there are valuable lessons for those researching similar topics with minority groups. IMPLICATIONS FOR PRACTICE/RESEARCH Involving people in health research topics with a stigma is possible. This paper highlights how this could be achieved using a community PA and the recruitment of community members as co-researchers. However, the PA is time-consuming and will depend on the skills of academic researchers in knowing and engaging with the community.

Evaluation of a new mental health liaison team in a general hospital. Part 2: exploring the themes and their effect on practice

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, part two of two on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, focuses on the perceptions and experiences of the MHLT participants, and explores three sub-themes derived from the interview data. The article considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital.

Influences on diagnosis and treatment of eating disorders among minority ethnic people in the UK

Purpose – Evidence, though limited, suggests that UK minority ethnic individuals have lower referral rates for eating disorders than their White British counterparts. Missed or delayed diagnosis may be an important contributory factor. This paper seeks to identify key areas that require attention for early detection and treatment of eating disorders in minority ethnic people.Design/methodology/approach – The approach taken was a community‐based qualitative study in Sheffield, England: interviews with relatives of people with eating disorders (n=3); key informant interviews (n=15); group discussions with community members aged 18‐24 (n=4, 24 participants).Findings – Several factors appear to influence the recognition of, and response to, eating disorders among minority ethnic people with potential implications for timely diagnosis and treatment. Low public awareness was an important barrier to seeking medical attention. Norms and ideals relating to food and body image, as well as some religious practices, ...

The occupation of accessing healthcare and processes of (dis)citizenship in UK Somali migrants: Sheffield case study

ABSTRACT In the UK free access to healthcare is regarded as a fundamental right accorded to all citizens, but there are significant health inequities experienced by ethnic minority populations. Accessing healthcare is an everyday occupation which can be made complicated by language issues and the design of communication systems. The example of people of Somali origin living in Sheffield is used to explore the occupational dimensions of access to healthcare as part of the participatory process of citizenship. Occupational analysis of healthcare access could contribute to better service provision.