Using Social Media to Improve Diabetes Care Among Low-Income Chinese Immigrants
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Lu Hu, PhD, a behavioral scientist and assistant professor in the Department of Population Health at NYU Langone Health, presented at the American Diabetes Association’s 81st Scientific Sessions. She received an NIH-funded K99/R00 award—a career development award for early stage and junior investigators to collect pilot data and be competitive in perspective grant applications—to examine the feasibility, acceptability and efficacy of a culturally and linguistically tailored social media-based intervention to reduce health disparities and improve access to care among low-income Chinese immigrants with type 2 diabetes.
The prevalence of diabetes and prediabetes has been steadily rising among Asian immigrants. From 2003 to 2013, the prevalence rose from 6.8 to 12.4 percent. Asian Americans are the fastest growing racial group in the U.S. and are estimated to pass 35 million by 2060. Chinese people were also less likely to participate in diabetes management behaviors and practices. One study found that Asian Americans reported lower adherence to feet and HbA1c checks when compared to Blacks and Hispanics. Hu stresses that because of the aforementioned factors, research is needed to prevent and mitigate type 2 diabetes.
The study was a single-group study composed of 30 low-income Chinese immigrants living in New York with type 2 diabetes. According to Hu, most participants reported an annual family income of less than $25,000. The intervention consisted of 24 culturally and linguistically tailored diabetes self-management education (DSME) videos. Over the course of twelve weeks, participants were sent two brief videos each week via WeChat, a free social app.
In Hu’s study, she discovered that among social media platforms, WeChat was the most popular option. “I think the reason is that WeChat is free. So you don’t need to worry about having an unlimited message plan,” Hu says. Coupled with accessibility, Hu adds that what makes WeChat a popular platform for intervention is that it is available in a variety of languages, including Mandarin.
After six months, a video watch rate of 92.2 percent was achieved. Additionally, HbA1c decreased from 7.4 to 6.8 percent among Chinese immigrant participants. “The participants also had very high satisfaction, meaning they were satisfied with our program,” Hu says.
Challenges For Chinese Immigrants Accessing Diabetes Care
There are a myriad of barriers that prevent Chinese immigrants from accessing care, including language. “Data reports that almost 60 to 70 percent of Chinese immigrants report limited English proficiency.” Hu says. Asian patients whose primary language is not English, may not be able to communicate with their providers, says Hu.
Additionally, existing diabetes education programs lack culturally-tailored interventions and many are based on a Western diet. “They [diabetes programs] talk about salad, cheese, pizza, but for many Chinese immigrants, they are still following a very traditional diet,” Hu says. She adds that while Asian immigrants in Hu’s study have limited English proficiency, the food discussed in traditional diabetes programs don’t translate because the foods mentioned are not what is eaten. Hu says that traditional Chinese food includes dumplings, buns, congee, rice, stir fried rice dishes, dim sum and hot pot. Therefore, foods discussed in traditional diabetes programs are not culturally tailored.
Asians are the least likely to get screened for diabetes. “Because Asians are perceived to be slim and their body mass index (BMI) is quite low, the doctors are less likely to screen for diabetes,” Hu says.
Coupled with the lack of access to culturally tailored interventions and screening, Asian immigrants also face extreme poverty. In a 2018 NYC Poverty Report, non-Hispanic Asians had the highest poverty rates when compared to other racial groups from 2012 to 2016. “If you take a look at the data, Asian immigrants, especially older adults over 65, actually have the highest poverty rate among all racial ethnic groups,” which puts hurdles when accessing diabetes care, Hu explains.
This data underscores the dissonance between mainstream depictions of Asians as “crazy rich Asians” and the real-world data that shows that Asians are living with the highest poverty rates, says Hu. She adds that the dissonance can be harmful because it makes it easier for policy makers and funding mechanisms to overlook Asians, and more specifically, Chinese immigrants in diabetes care: “Chinese immigrants are overlooked, which has implications for funding and policy for this community.”
Study Future
Currently, Hu and her team are seeking additional funding to expand the program, where they hope to involve the participation of family members to see whether they will have a larger impact on diabetes management among participants.
Hu hopes that her research can be sustainable and scalable to other populations. “We believe this is really a great program model for low income or rural populations where access is a huge barrier,” Hu says.
“Usually people assume that technology won’t work for racial ethnic minorities, but actually, it can be done. And we have demonstrated just using simple text messages, we can help people to improve their efficiency and achieve great health outcomes,” Hu says.
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