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Raising awareness of type 2 diabetes in a UK Turkish population

Debbie Hicks, Kit McAuley

There are an estimated 100 000 Turkish nationals and 300 000 British people of Turkish origin in the UK. A significant proportion of these are living in the Borough of Enfield, where they account for 3.5% of the local population, and Turkish Cypriots account for a further 3.8%, making this group the largest ethnic group in Enfield (Enfield Racial Equality Council, 2004). From the beginning of the Diabetes Redesign Project in Enfield in 2005, it was recognised that much work was needed among ethnic groups to ensure equity of access across all cultural groups living in Enfield. This article describes an awareness project that took place in November 2008 specifically aimed at targeting the Turkish community of Enfield.

There appears to be an increased prevalence of type 2 diabetes as well as diabetes-related complications among the Turkish population. The Turkish Diabetes Epidemiology Study (Satman et al, 2002) indicated that the crude prevalence of type 2 diabetes in Turkey was 7.2%.

Many people from ethnic groups do not seek advice at diabetes onset. There may be a number of reasons for this, including: 

  • Limited understanding of the causes and prevention of diabetes.
  • Lack of awareness of symptoms.
  • Reluctance to visit a doctor.
  • Inability to understand provided information.

Education and information about diabetes was found to be inadequate for all people with diabetes in the UK (Audit Commission, 2000).  However, people from ethnic populations are twice as likely to report a lack of understanding about their condition as their white British counterparts (Hill, 2006).

In 2005, Enfield PCT recruited a diabetes team to ensure that the people of Enfield had access to high-quality diabetes care in the community setting. The philosophy of the diabetes nursing team, from the outset, was to provide evidence-based diabetes care of a high standard that is accessible to all, regardless of ability, race or religion (Hicks and McAuley, 2006).

One of the first tasks that the team undertook was a series of diabetes awareness sessions for the five biggest ethnic groups resident in Enfield. A very disappointing turnout was noted at the awareness event held for the Turkish community, and the team became determined to ensure that they would readdress the issue of improving communication and links with this group. 

The Enfield Turkish Community Diabetes Awareness Initiative
In 2008, the Enfield diabetes team were fortunate enough to successfully bid for an unrestricted educational grant from the pharmaceutical industry to improve diabetes awareness in the locality. The aims of the Enfield Turkish Community Diabetes Awareness Initiative were to:

  • Increase understanding and awareness of diabetes among the Turkish population of Enfield.
  • Educate the Turkish community on healthy lifestyle measures and the prevention of diabetes.
  • Recognise symptoms to ensure a prompt diagnosis.
  • Provide optimal diabetes management for those with diabetes to reduce the risks of complications.

It became clear that a multidisciplinary team approach would need to be undertaken to ensure the success of the Turkish awareness event in meeting its aims. The diabetes team approached one of their community dietitians, who was very keen to help, as well as a successful health trainer team manager and a community pharmacist. The planning group decided that the project would culminate in an awareness event that would coincide with World Diabetes Day on Friday 14th November 2008. The venue for this event was Edmonton Green Market, which is one of the busiest local shopping areas and is in the heart of the Turkish community in Enfield. As there are many shops and stalls selling foods relevant to many different cultures, the team felt that there were also opportunities to engage with numerous other ethnic groups as well as the Turkish community. 

Prior to the organisation of the project, Rahme Oykener, an Enfield health trainer fluent in Turkish, undertook a series of interviews with Turkish people with diabetes to find out more about how the condition affects their everyday lives, how their diabetes was diagnosed, how it is managed and how they access current support networks. 

Most respondents in the survey highlighted the strong desire to retain their cultural identity (traditional Turkish food, exposure only to Turkish media) and reiterated many of the challenges that Enfield PCT had encountered in previous efforts to reach this community. Many of the difficulties accessing the Turkish population in the past were the result of language barriers and cultural issues; it was found that this may also include the unwillingness of some Turkish men to engage with female healthcare professionals.

As a result of the information gleaned from this exercise, the planning group also suggested additional activities (support materials, a Turkish recipe booklet, screening for diabetes and informing the media) to support the World Diabetes Day event at Edmonton Green.

Support materials
The diabetes team at Homerton Hospital had already made great progress in the translation of diabetes-related information into Turkish. The authors’ team were delighted to find that they were able to reproduce their work with acknowledgements. This information was then put on the Enfield diabetes website and reprinted to hand out at the awareness event. The health trainer team also had information and visual aids regarding smoking cessation, BMI calculation, healthy eating and exercise, relevant to all ethnic communities.

Turkish recipe booklet
A 20-page Turkish recipe booklet entitled Sagliki Yasam (Good Health), was developed in collaboration with a Turkish chef, Hulya Erdal. The booklet contains five traditional Turkish recipes that were adapted by the community dietitian to make them healthier. The booklet also contains information about diabetes and the diabetes team.

These recipe booklets were given out at the stand in Edmonton Green. Numerous people commented on how useful they thought that they would be. Additional recipe booklets were also sent to all GP practices in Enfield. Informal feedback from practice staff has also been very positive, and if funds become available in the future an updated version will be created. 

Screening for diabetes
Enfield have an established coronary heart disease (CHD) screening programme, carried out by 15 community pharmacies throughout the borough. This screening service aims to identify groups of the population with high risk factors for the development of CHD and diabetes. These selected pharmacies test cholesterol and glucose levels, blood pressure, weight and BMI. One of the pharmacies that was part of this project was located at Edmonton Green Shopping Centre. The pharmacist was keen to be involved in the awareness project and agreed to screen members of the public who were deemed to be “at risk” by the diabetes team. Screening took place either at the awareness event or people were offered an appointment to be screened in the near future. An “at risk” checklist was put together for members of the public to ensure that resources allocated for screening were used appropriately. 

Media outreach
To generate awareness of this Enfield PCT health initiative and to publicise the launch event to take place at Edmonton Market on the 14 November, news editors and reporters from London’s Turkish papers and local Enfield papers were invited to a press briefing held at local councillor Ertan Hurer’s office on Monday 10 November. Throughout the media outreach activities Councillor Hurer was supportive of the project and offered valuable insight into the community. 

As part of the media outreach, close links were also made with Suzanne Ahmet at the Turkish Women’s Support Group (TWSG) and Aiser Osman at the Turkish Women’s Philanthropic Association (TWPA). Both were able to lend their support to the initiative and publicised the event to their groups.

Diabetes awareness event on World Diabetes Day
The diabetes awareness stand was located in a busy, enclosed area of the shopping centre, close to the pharmacy so that people could easily be screened. Two members of the Enfield diabetes nursing team and five members of the health trainer team were present. In all, five different cultural groups were represented, and included one Turkish-speaking member of staff. 

Information was available that was relevant to all major cultural groups with regard to the signs and symptoms of diabetes as well as healthy eating, smoking cessation and exercise. A carbon monoxide detector was available and proved very popular with people, as were waist measurements and the availability of pedometers.

Evaluation of the day showed that the public seemed pleased to have healthcare professionals available to ask questions about lifestyle issues. People with diabetes also appeared to engage with the team and numerous people asked questions about their current diabetes management. On the day of the event 23 people underwent full screening checks at the pharmacy and a further 50 people had blood pressure checks. Feedback from the pharmacist and manager at the pharmacy was very positive and they exceeded their target for screening for the quarter on this day alone.

During the day, a Turkish TV camera crew visited the stand and transmitted further information to the Turkish population.

Conclusion
All those involved in the Enfield Turkish Community Diabetes Awareness Initiative felt that it had been a huge success. Only one negative comment was noted and this was in relation to not having an awareness event specifically aimed at the white British population of Enfield. 

The many people that engaged with healthcare professionals on the stand or took literature away with them will also have an increased understanding of other issues, such as diabetes prevention, recognition and management, and also more general health lifestyle measures.

The overall success of this awareness initiative would not have been possible without the unrestricted educational grant received from sanofi-aventis and the organisational support from Huntsworth Health. We are very appreciative for their support. 

REFERENCES:

Audit Commission (2000) Testing Times: A Review of Diabetes Services in England and Wales. Audit Commission, London
Enfield Racial Equality Council (2004) Ethnicity and Enfield. EREC, Edmonton. Available at: http://tiny.cc/rQQk3 (accessed 03.12.09) 
Hicks D, McAuley K (2006) Redesigning diabetes services and its benefits. Journal of Diabetes Nursing 10: 304–8
Hill J (2006) Management of diabetes in South Asian communities in the UK. Nurs Stand 20: 57–64
Satman I, Yilmaz T, Sengül A et al (2002) Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 25: 1551–6

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