title: Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for systemic change.
abstract: OBJECTIVE
  To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants.
  
  
  METHODS
  Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu.
  
  
  METHODS
  Toronto, Ont.
  
  
  METHODS
  A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less.
  
  
  METHODS
  Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care).
  
  
  RESULTS
  A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses (P= .0233), and the quality of the provider-patient relationship (P= .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices.
  
  
  CONCLUSIONS
  Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management.
authors.affiliation: Consultant in Research and Evaluation and Adjunct Professor at the Dalla Lana School of Public Health at the University of Toronto in Ontario. i.hyman@utoronto.ca.
authors.forename: Ilene
authors.initials: I
authors.lastname: Hyman
authors.affiliation: Senior Research Scientist at Access Alliance Multicultural Health and Community Services in Toronto.
authors.forename: Yogendra
authors.initials: Y
authors.lastname: Shakya
authors.affiliation: Data Analyst at the Institute for Clinical Evaluative Sciences in Toronto.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Jembere
authors.affiliation: Associate Professor in the School of Nutrition at Ryerson University in Toronto.
authors.forename: Enza
authors.initials: E
authors.lastname: Gucciardi
authors.affiliation: Full Professor in the Faculty of Nursing at the University of Montreal in Quebec.
authors.forename: Bilkis
authors.initials: B
authors.lastname: Vissandjée
mesh_terms: D001459:Bangladesh / Q000208:ethnology; D002681:China / Q000208:ethnology; D065246:Culturally Competent Care; D003920:Diabetes Mellitus / Q000191:economics / Q000208:ethnology / Q000523:psychology*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010154:Pakistan / Q000208:ethnology; D011369:Professional-Patient Relations; D012648:Self Care / Q000191:economics / Q000523:psychology*; D012959:Socioeconomic Factors; D013188:Sri Lanka / Q000208:ethnology; D011795:Surveys and Questionnaires