Katarina Hjelm, Dept of Community Health Sciences, Lund den 26 :e januari, 1999 kl 18:46

MIGRATION, HEALTH AND DIABETES MELLITUS

Studies comparing foreign- and Swedish-born diabetic subjects living in Sweden Akademisk avhandling som med vederbörligt tillstånd av Medicinska fakulteten vid Lunds Universitet för avläggande av doktorsexamen i medicinsk vetenskap kommer att offentligen försvaras i Carolinasalen, Lunds Universitet Lunds Universitet fredagen den 15 januari 1999, kl. 9.00 av Katarina Hjelm leg. sjuksköterska och vårdlärare Institutionen för Samhällsmedicinska Vetenskaper Dalby/Lund

Fakultetsopponent:
Professor Urban Rosenqvist, Socialmedicinska institutionen Uppsala Universitet, Department of Community Health Sciences ISRN LUMEDW/MECH-1027-SE

Migration, health and diabetes mellitus - Studies comparing foreign- and Swedish-born diabetic subjects living in Sweden

To study the influence of migration on health in migrant diabetic subjects, foreign-and Swedish-born persons were compared as regards objective and subjectively perceived health in relation to social position, and beliefs about health and illness and their influence on self-care and care-seeking behaviour. Persons (foreign- and Swedish-born) with known diabetes mellitus (DM), aged 16–74 years, were chosen from two different counties in Southern Sweden (n = 143/1384; 113/1564), and from a random sample of the Swedish pop-ulation, the annual Swedish Survey of Living Conditions (n = 31/446). They were studied by medical records, clinical examination, standardised and structured interviews. Health care staff in diabetes care (n = 149) answered a questionnaire regarding their perceptions of beliefs about health and illness in migrants. Women born in Ex-Yugoslavia and Sweden (n = 13/15, 33–73 yr) were interviewed in focus groups. Foreign-born, mainly respondents from European countries, stated poorer subjectively perceived health than Swedish-born subjects. This was more strongly related to socioeconomic factors than country of birth as an indicator of migration experiences. No major differences in objective health (prevalence of DM, glycaemic control and complications) were found. Glycaemic control was related to low social position irrespective of origin. Indicators of low social position were risk factors of self-reported DM. Migrants, especially Yugoslavians and non-Europeans, were perceived to differ from Swedes in being less knowledgeable about bodily function and diabetes. Yugoslavian females gave less concrete examples of beliefs about health and illness, focused on migratory experiences, enjoyed life by making deviations from dietary advice and retaining former traditions, were less inclined to self-monitoring and preventive foot care, expressed dependency on health care staff and discussed the influence of supernatural forces. Thus, beliefs about health and illness differ between migrant and Swedish-born diabetic subjects and are essential for self-care practice and care-seeking behaviour. Migrational background affects health, and socioeconomic circumstances and cultural beliefs are of crucial importance in the management of DM. Migrants, diabetes mellitus, prevalence, glycaemic control, diabetes mellitus complications, social class, health services needs and demand, perceived health, lifestyle, health care professionals, health/illness beliefs, self-care, care-seeking behaviour. Katarina Hjelm, Dept of Community Health Sciences, Lund University, S-223 54 Lund, Sweden

List of publications
This dissertation is based on the following papers which are referred to by their Roman numerals: I Hjelm K, Isacsson Å, Apelqvist J, Sundquist J, Nyberg P. Foreign- and Swedish-born diabetic patients – a population-based study of prevalence, glycaemic control and social position. Scand J Soc Med 1996;24:243–52. II Hjelm K, Apelqvist J, Nyberg P, Sundquist J, Isacsson Å. Health, health care utilisation and living conditions in foreign-born diabetic patients in southern Sweden. J Int Med 1997;242:131–41. III Hjelm K, Sundquist J, Apelqvist J. The influence of socioeconomic status and lifestyle on self-reported health in diabetics and non-diabetics: A comparison of foreign- and Swedish-born individuals. Submitted for publication. IV Hjelm K, Isacsson Å, Apelqvist J. Health care professionals’ perceptions of beliefs about health and illness in migrants with diabetes mellitus. Practical Diabetes International 1998;15:233–7. V Hjelm K, Isacsson Å, Apelqvist J. Beliefs about health and illness essential for self-care practice – a comparison of migrant Yugoslavian and Swedish diabetic females. Submitted for publication.