Language Barrier One Roadblock to Diabetes Control for Chinese Immigrants

Health providers helping Chinese-speaking Asian American immigrants with diabetes better control their disease to avoid complications need to do more than just have translators and bi-lingual staff in hospitals or doctors' offices. While that's a start, these patients also need comprehensive patient education materials written in Chinese and a medical staff thoroughly versed in the customs and cultural issues that may impede their diabetes care, according to a new study by researchers at Joslin Diabetes Center.

The Chinese-speaking immigrants who were surveyed at community health centers in Boston, New York City and Oakland, Calif., were found to have less knowledge of how to manage their diabetes - and generally had a trend toward poor blood glucose control - compared with Asian American immigrants who preferred to speak English, according to William C. Hsu, M.D., who led the pilot study along with his colleagues in Joslin's Asian American Diabetes Initiative (AADI).

But after being given a bilingual diabetes education book, the participants showed improved understanding of their disease and a trend toward improved blood glucose control in laboratory tests.

The study, which appears in the February issue of the American Diabetes Association's journal, Diabetes Care, is among the first of its kind to explore language barriers to diabetes management among Chinese-speaking immigrant populations.

"The study is particularly important because Asian Americans have at least a 50 percent greater risk of developing type 2 diabetes and pre-diabetes than Caucasian Americans," says Dr. Hsu, Co-director of Joslin's AADI. This fact is little known among both Asian Americans and physicians because Asian Americans are less likely to be overweight or obese. More than 10 percent of Asian Americans have diabetes. If poorly controlled, diabetes can lead to costly and devastating complications, especially stroke and kidney disease in Asian Americans.

"The health policy implications of the study are broad for immigrants and other non-English speaking people and should be explored in other populations as well," Dr. Hsu says. "Even in culturally competent healthcare settings like community health centers, our study shows the importance of having materials written in the native language to improve non-English speaking patients' understanding of the disease and reduce disparities in healthcare."

Translators Not Enough

In the Joslin study, the researchers surveyed 52 Asian American immigrants with type 2 diabetes at three community health centers. The patients, aged 18 to 70, had diabetes for at least a year and were taking oral medications or insulin. They were asked if they preferred to speak Chinese or English and then were quizzed by the researchers about their diabetes knowledge. Twenty-two of the patients preferred to speak English, having immigrated at an early age or been born in the United States; the remaining 30 preferred Chinese. The Chinese-speaking group scored an average of nearly 63 percent vs. 85 percent for the English-speaking patients on a test of diabetes knowledge. In their dealings with healthcare professionals, the Chinese-speaking group reported requiring translation 35 percent of the time. The 11 patients that required translation scored lower than the others on the diabetes knowledge test.