Abstract
Background
The prevention and management of Type 2 diabetes mellitus has become a concern in Inuit communities across Canada. Although Inuit living with diabetes in remote Canadian Arctic communities could help guide the development of health services, their voices have not been heard. The experiences and perceptions of Inuit themselves are often overlooked in research. In this study, Inuit living in a small rural Arctic community on Baffin Island were invited to share their experiences of living with diabetes.
Methods
A qualitative multi-case study approach was taken. In-depth interviews (n=4), field observations, and informal interviews over one month in the community were used to build and contextualize the cases. In-depth interviews were transcribed, and analyzed using holistic thematic analysis and open coding.
Results
Accessibility was a concern with respect to foods, health knowledge, language interpretation and health services. In all methods of analysis, the importance of language and effective cross-cultural communication figured prominently. It was also evident that trust and rapport is crucial when discussing diabetes. There was strong interest in promoting diabetes education and prevention within the community.
Interpretation
These findings suggest that current health education and services may not be adequate for this setting. The voices of Inuit should be integral in steering the direction of their future diabetes education and health service delivery. Focusing on language barriers may help to improve the accessibility of knowledge about diabetes and nutrition, and enhance relationships between non-Inuit health service providers and Inuit.
Keywords: Storytelling, Inuit, diabetes, language, access, health services
Résumé
Contexte
La prévention et la prise en charge du diabète de type II deviennent préoccupantes dans les communautés inuites du Canada. Les Inuits diabétiques qui vivent dans les communautés éloignées de l’Arctique canadien pourraient contribuer à l’élaboration des services de santé qui leur sont destinés, mais leurs voix ne sont pas entendues. L’expérience et les perceptions des Inuits eux-mêmes sont souvent négligées par la recherche. Nous avons donc invité des Inuits vivant dans une petite communauté rurale arctique de l’île de Baffin à partager leur expérience du diabète.
Méthode
Nous avons effectué une étude qualitative de plusieurs cas. Des entretiens en profondeur (n=4), des observations sur le terrain et des entretiens informels se sont déroulés dans la communauté sur une période d’un mois afin d’étayer les cas et de les mettre en contexte. Les entretiens en profondeur ont été transcrits et analysés selon une méthode d’analyse thématique holistique et un mode de codage ouvert.
Résultats
L’accessibilité aux aliments, aux connaissances sur la santé, à l’interprétation linguistique et aux services de santé est problématique. Quelle que soit la méthode d’analyse, l’importance de la langue et les communications transculturelles efficaces figurent au premier plan des préoccupations. Il est clair aussi que la confiance et le lien avec le patient sont des éléments cruciaux lorsqu’on discute du diabète. Les membres de la communauté se sont montrés très intéressés à promouvoir l’information et la prévention en matière de diabète.
Interprétation
Il semble que l’information et les services sanitaires actuels laissent à désirer dans le milieu à l’étude. Les voix des Inuits devraient être entendues lorsqu’on s’efforce de déterminer les orientations futures de l’information et de la prestation des soins du diabète. En s’attaquant aux barrières linguistiques, il serait possible d’améliorer l’accès aux connaissances sur le diabète et la nutrition et de bonifier les relations entre les Inuits et le personnel soignant non inuit.
Motsclés: récits, Inuits, diabète, langue, accès, services de santé
Footnotes
Acknowledgements: This project was supported by the McGill Max Bell Foundation, and a grant from SSHRC. The authors thank Emily Karpik for translations and interviews and Guylaine Charbonneau-Roberts for assistance in the field
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