Overcoming family and cultural challenges for Chinese American patients with diabetes: Provider guidelines

Abstract

Despite unique cultural beliefs regarding health and family roles for Chinese immigrants, limited clinical guidance is available for primary care providers to addresses T2DM in this population. Our aim was to articulate cultural and family challenges in T2DM and detail clinical guidance for clinicians. Method: As part of a CBPR intervention trial, interdisciplinary Chinese and American researchers, community partners, and a Chinese American CAB created clinical recommendations based on: a) evidence on Chinese health beliefs and practices, b) prior interpretive study of this population by our research team and c) practical clinical wisdom of community partners: a Community Health Center and a historically significant social service agency serving new Chinese immigrants. Results: A structured clinical guideline (in Chinese and English) highlighted cultural and family challenges to T2DM management, and potential provider responses. Cultural health challenges included (partial list): Chinese health metaphors centered on balance versus control; dietary preferences that contradicted diabetes diets; respect for authority inhibiting querying health providers; face concerns constraining illness disclosure and family support requests; communal concerns that prioritized relationships over diabetes adherence; and preferences for authoritative versus collaborative health care approaches. Provider guidelines included: employing Chinese health metaphors (balance); highlighting self-care as a form of family care; flexibly providing both directive medical advice and encouraging patient agency, and normalizing diabetes as a chronic but not disabling condition. Dissemination of guidelines to local primary care clinics has been positively reviewed. Implications: Caring for ethnically diverse populations is demanding for diabetes providers and evidence-based guidelines for culturally tailored care is warranted.