Cultural, communication barriers hamper diabetes, obesity care for US Tongan community
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A lack of cultural understanding has created a void between Tongans living in Utah and health care providers, according to a speaker at the Association of Diabetes Care & Education Specialists annual meeting.
“The study group has many challenges, conflicts, misinformation and a lack of information about their situation, and they face many challenges in dealing with their illnesses,” Gladys S. Adjei-Poku, PhD, nurse manager at University of Utah Health, told Healio.
The Tongan community has a higher prevalence of diabetes and obesity compared with other ethnic groups in the United States, according to Adjei-Poku, and Native Hawaiian and Pacific Islanders are the fastest-growing ethnic group in the country.
Adjei-Poku conducted a qualitative study for which she interviewed adults of Tongan descent living in Utah. All of the participants attended the same church, and Adjei-Poku visited each of them at their homes and conducted interviews lasting 2 to 3 hours. The interview questions focused partly on eating habits and how food affects social standing in the community.
“It was interesting to learn that, although the Tongan participants understand the health implications of their ethnic dietary practices, they feel obliged to frequently attend social events, which are planned around an abundance of food, in order to feel a sense of belonging in society,” Adjei-Poku said. “Compounding the problem is the fact that the foods served at home and social gatherings are mainly fatty red meats and starchy roots.
“People are supposed to practice cultural hospitality by serving friends, families and even strangers who come to their homes or events,” Adjei-Poku said. “It is customary for Tongans to eat with guests who come through their doors, even if the hosts have just eaten a meal. Sitting down at the table to eat with guests shows love, connectedness and belonging. Guests eat to honor and respect their hosts. ... This expectation leads to both the hosts and the guests eating more.”
The study also revealed some participants did not acknowledge the risks for obesity and diabetes. Financial issues and affordability of healthy food were also a concern.
The study findings revealed a lack of communication between some of the participants and health care professionals. Adjei-Poku said a few factors contributed to this; for example, the study participants reported being generally quiet and not forthcoming with information to providers. Some of the participants also said they did not feel providers understood their culture.
Adjei-Poku encouraged providers to come up with culturally oriented intervention plans so Tongans can eat healthier while also staying true to their traditions. One example is to ask someone who is looking to lose weight to eat less of the cassava root, a big part of the traditional diet, and substitute it for more cassava leaves to cut down on starch.
In addition, Adjei-Poku said providers can improve their relationship with their Tongan patients by taking time to listen and express empathy.
“We need to be more culturally sensitive, to validate that their culture is very interesting,” Adeji-Poku said. “We are here to learn more from them, and we are interested in hearing about everything about the tradition.”
In the future, Adjei-Poku wants to study how providers perceive Tongans and whether that perception contributes to the health care challenges the community faces.
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Adjei-Poku G. Lived Experience of Tongans with Obesity and Diabetes. Presented at: Association of Diabetes Care & Education Specialists Annual Meeting; Aug. 13-16, 2020; (virtual meeting).
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