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Abstract: Racial and ethnic disparities in diabetes care have been well documented. While root causes have been explored for some minority groups, less is known about smaller immigrant populations such as Cambodians. In this study, we sought to explore the potential barriers to care for Cambodian patients with diabetes. We conducted five focus groups with three study groups: health care providers, bilingual Khmer frontline staff, and Cambodian patients with diabetes. Focus groups findings revealed that certain cultural beliefs, low health literacy, and language barriers strongly affect Cambodian patients' understanding of diabetes and self-management, as well as clinicians' ability to care effectively for Cambodian patients with diabetes. Our study supports previous literature and also adds several new insights not previously described. We recommend education for health care providers on patient-centered, cross-cultural care with an emphasis on the needs of Cambodians as well as culturally appropriate diabetes education for patients.
Key words: Health care disparities, diabetes mellitus, type 2/diagnosis, culture, cultural competence, health literacy, qualitative research, focus groups, Cambodia ethnology, United States.
Type 2 diabetes is a complicated chronic disease with rapidly increasing rates of diagnosis.1-3 The rates of obesity,4-8 which is a major risk factor for diabetes, are also rapidly increasing. According to recent estimates, 11.3% (25.6 million) of the United States population aged 20 years or older has diabetes, and for some racial and ethnic minorities the prevalence of diabetes is even higher (7.1% of non-Hispanic Whites versus 8.4% of Asian Americans, 11.8% of Hispanics, and 12.6% of non-Hispanic Blacks).9 Some ethnic sub-populations, including Cambodian Americans, also have an elevated incidence of type 2 diabetes and are at greater risk for related complications, based on the limited data available.10-17 A study of the second largest Cambodian American community in the U.S. (in Lowell, Massachusetts) showed that a disproportionate share of Cambodian adult deaths were attributable to stroke and diabetes, compared with all other adults in the state.18 Further, research shows that Cambodian refugees have poor health relative to the general United States and other Asian American and Pacific Islander populations.19-20
Racial and ethnic disparities in diabetes care have been well-documented. For ex- ample, African Americans and Latinos display poorer glycemic control21-23 and receive fewer glycohemoglobin tests22'24 than their White counterparts. Blacks are also less...