None / Introduction: As the prevalence of diabetes continues to rise in Canada, South Asians, as the largest visible minority group in Canada, are at higher risk for developing diabetes than the general population. Although diabetes self-management education (DSME) interventions for South Asians with type 2 diabetes (T2DM) have been researched, these interventions have not been assessed for their cultural congruency. Methods: This systematic review examined the effectiveness of DSME interventions for South Asians with T2DM. Electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL and CINAHL) were searched since inception, along with relevant reviews and guidelines. Title and abstract and full text screening were conducted independently by two reviewers; data extraction was done by one reviewer and confirmed by another. Quality assessment of the included studies was completed using the Cochrane Risk of Bias tool; cultural congruency was assessed using Leininger’s Sunrise Model. All results were synthesized narratively. Results: A total of 1259 studies were found in the search, of which only four randomized controlled trials (RCT) met the inclusion criteria. All studies were consistent in showing a reduction in A1C following the intervention; however only one study reported statistically significant reductions in A1C. Interventions were conducted in person, with follow-up periods ranging from six months to two years, with the use of South Asian community link workers in most interventions. Bias was identified across all studies for sequence generation, allocation concealment and blinding. All studies had limited evidence of cultural congruency, particularly for gender roles and responsibilities. Conclusions: This review found limited effectiveness of culturally specific DSME interventions for South Asians with T2DM. Furthermore, the interventions were scant in their description of cultural congruency. Future research ought to begin with designing interventions for cultural congruency and improved methodologies for DSME research to improve internal and external validity. / Thesis / Master of Science (MSc) / South Asians are the largest visible ethnic minority group in Canada and are at high risk of developing type 2 diabetes (T2DM). This research project aims to understand how diabetes self-management education (DSME) and support (DSMS) is delivered to South Asians with T2DM and how these practices are culturally tailored. The scientific literature was searched using electronic databases to find 1259 research studies, of which four examined the effectiveness of DSME/DSMS provided to migrant South Asians with T2DM. Only one study showed significant improvements in blood glucose control. All of the four studies contained several DSME/DSMS components and they all failed to address differences in gender roles and responsibilities in relation to South Asian culture. Thus, there is a need for future studies to design DSME/DSMS interventions that are culturally tailored to improve blood glucose control and thus, improve the health and well-being of South Asians with T2DM.

The main argument in this dissertation is that changes in male nuptiality in rural India between 1921 and 1981 was a form of household adaptation to wage dependency and proletarianization in the countryside. The male nuptiality in rural India in 1921 was characterized by extremely early marriage throughout the country. Under conditions of high mortality of that period, early marrying men had an advantage in forming joint households (with both parents present). Male nuptiality in rural India grew more diverse in 1981, and came to be characterized by at least two distinctive nuptiality regimes: One which strongly resembled peasant nuptiality of the early 20th century and the second represented an emergent adult pattern of nuptiality among males in rural India. The variation in marriage age of males in rural India was significantly related to the level agricultural proletarianization in 1981. Regions characterized by early male nuptiality were generally dominated by household-based or peasant production, while regions of later marriage among males were more likely to have a substantial wage labor sector. Due to declines in mortality, the possibility of young men living in a joint household with both parents rose between 1921 and 1981, regardless of age at marriage. But within each level of mortality, early marrying men still had better chances of being able to form a joint household (with both parents). Marriage postponement among males in some parts of rural India may have modified many aspects of the household development process. More important, it may have allowed greater flexibility with respect to the timing of household formation, and also ensured that men were financially able to support a family when they married.

South Asians are a diverse population with unique genetic, cultural, and environmental factors that directly impact their overall health. Pre-disposed to several chronic illness such as cardiovascular disease, diabetes, obesity, and even some cancer, it is incredibly important to have adequate health data on this demographic to help diagnose and prevent these disease states. However, there is very limited data on South Asians and the reason behind this is multifold. First, barriers exist that specifically impact participation rates in ethnic minority groups such as South Asians. Next, a majority of clinical research studies utilize aggregated race and ethnicity categories, such as White, Black, Asian, American Indian, and Latino, which tend to cover up the individual health needs of its ethnic subgroups like South Asian. A literature review involving 20 published works and texts was carried out to determine the barriers that prevent clinical trial engagement in South Asians. The primary reasons for lack of involvement of South Asians in clinical trials were language difference, trial burden, lack of information, mistrust, gender roles, and of course the systemic insufficiency in actively recruiting specifically South Asian populations. In order to achieve health equity, it is essential to understand health disparities that exist within the system and work to find methods to alleviate them.

No description available.

This study focuses on understanding the experiences of bereaved South Asian family caregivers living in Canada. Findings suggest that South Asian caregivers face several challenges and that there is a need for a more culturally sensitive palliative approach to care. / The South Asian population faces several challenges when receiving palliative care, including language barriers, unawareness of resources, and poor cultural awareness among health care providers (HCP). However, little is known about the needs of South Asian family caregivers in Canada. The purpose of this study is to understand the experience of bereaved South Asian informal caregivers, who cared for a family member in their last year of life. An interpretive descriptive design was used. Eleven participants were recruited by referral through a community hospice and a community health centre. Participants were South Asian informal caregivers and at least two months bereaved. Audio-recorded one-on-one interviews were conducted followed by a thematic analysis of the transcripts. Five themes were identified to describe the experience of bereaved South Asian informal caregivers: transforming perceptions of life and death, the influence of culture on the experience; the challenges of being a caregiver; coping with the challenges of care-giving; and getting support. Caregivers expressed feeling a sense of duty to their family members and were reluctant to utilize long-term care homes or hospices. The perceived hierarchy of HCP roles also affected their experience. In reflecting on their experiences, caregivers had a deeper appreciation for life and were more willing to talk about death and dying. The experience of South Asian family caregivers is complex with several underlying cultural influences. This study has important implications in improving the delivery of culturally sensitive palliative care and developing supports that address the challenges experienced by caregivers in the South Asian community. / Thesis / Master of Science (MSc) / The South Asian community faces many challenges when receiving palliative care, including language barriers and health care providers (HCP) who do not understand the South Asian culture. However, little is known about the needs and experiences of South Asian family caregivers. In this study, South Asian caregivers of family members who recently died described their experience of being a family caregiver. Caregivers had a strong sense of duty to their family members and were against moving their family members into long-term care homes or hospices. Their understanding and views of HCPs’ roles affected their experiences. Caregivers also had more appreciation for life and wanted to talk about their wishes for their own death with their family members. The findings of this study can help improve the delivery of palliative care for the South Asian community and can help HCPs better support their South Asian patients and families.

An interpretive description qualitative approach was utilized in this study. The main aim to was to understand the South Asian (SA) Punjabi community’s experience of having accessed mental health services for depression within Ontario, Canada. A sub-aim was to capture the participants’ conceptualizations and experiences of having depression, which provided context about this ethnic community and deepened insights into their accessibility experience. Six Punjabi persons living with depression (PLDs) and six family members were interviewed in Punjabi and/or English. Data analysis was guided by Thorne’s strategy for interpretive description. Twelve major themes detailed the challenges of PLDs and their family members regarding i) identification and understanding of depression and ii) accessing mental health support. Major themes revealing the community’s conceptualizations of depression are: i) most of us didn’t know what depression is, ii) we realized it was depression after getting help, iii) we keep depression a secret, iv) my family didn’t understand my depression, v) my family helped, vi) my family didn’t help- some made me sick, and vii) my family also became “sick”. These themes supported a better understanding of the major themes discussing the community’s access to mental health service for depression, which are: viii) we didn’t know where to get help, ix) my health providers’ lack of familiarity with my culture caused stress, x) I waited to get help, xi) treating my depression cost me, and xii) knowing my culture will help you treat me better. Findings of this qualitative study provide details of how these participants had their own unique cultural conceptualizations of depression and continue to experience difficulty with accessibility of mental health services while receiving care. Results suggest culturally tailored improvements of mental health service accessibility are required to support this population as they navigate the mental health system for their depression. / Thesis / Master of Science (MSc)

Yes / Patient and public involvement is imperative to ensure relevance of research. There is a growing literature on the theoretical underpinning on patient and public involvement including level and processes of involvement. The aim of this paper is to describe a person-centred and culturally sensitive approach to working with minority ethnic communities, involving carers, people living with dementia, members of the public and carer support workers, as used in the Caregiving HOPE study; and the influence of the approach on the study’s research processes and outcomes. Patient and public involvement members were considered experts by experience and involved with study conception, design, conduct and dissemination. The perspective of the experts by experience is also presented in this article. The level and nature of involvement was influenced by each individual’s needs and desires which changed over the course of the study. The approach had a significant impact on study outcomes as evidenced by successful recruitment and engagement at a national level, but was not without challenges with greater flexibility required and fuller consideration of financial and time costs required. Benefits of the approach included strong engagement, improved outcomes (successful recruitment of seldom heard groups) and meaningful relationships between researchers and experts by experience. A person-centred and culturally sensitive approach is required with patient and public involvement to ensure involvement is not detrimental to those involved, is meaningful and enjoyable and has a positive impact on the research. / Alzheimer’s Society under grant 237 (AS-JF-14-005).

No / Background: Cognitive deficits are a core symptom of schizophrenia, severely debilitating and untreated by current medication. However, to date there is limited research focusing on the precise nature of the cognitive disturbances at first episode in ethnic populations. Improved understanding of this will allow improved approaches to therapy. The aim of this study was to investigate cognitive function with a first episode of psychosis South Asian patients. Methods: Twenty South Asian first episode psychosis patients and 15 healthy South Asian matched controls were recruited. All were second generation South Asian people living in the UK. Subjects who took part in the study completed the Positive and Negative Syndrome Scale (patient group), the Wechsler Test of Adult Reading and a battery of neuropsychological assessments to assess specific domains of cognition of relevance to Measurement and Treatment Research to Improve Cognition in Schizophrenia using the Cambridge Neuropsychological Test Automated Battery (CANTAB) (all groups). Results: Results show that first episode patients performed significantly worse than controls across all cognitive domains tested using CANTAB. Significant impairments were found in tests of visual and spatial memory, executive function, working memory, spatial planning and attention. Importantly, a number of cognitive performance indices (visual memory, spatial memory, executive function) were positively correlated with the severity of negative symptoms. Conclusion: We demonstrate that first episode South Asian patients display significant and specific cognitive deficits with evidence to support an association between negative symptoms and certain cognitive domains at first episode in this patient population.

Yes

This study examines the psychological and emotional experience of settling in Canada for South Asian Muslim newcomers and the coping systems they use to manage the challenges associated with moving to a new country. Ten South Asian Muslims were interviewed within the Greater Toronto Area. They were posed questions related to the hardships they encountered as they settled in Canada and how they managed those challenges. The data was analyzed using Grounded Theory. A model was developed to illustrate resources used by newcomers to help maintain their mental health and well-being. Upon settling in Canada, the participants experienced psychological stressors and therefore sought help from their Islamic faith, their families, and community services. The combined resources facilitated the immigrants’ resilience and allowed them to maintain a positive outlook towards their immigration experience.