Prevalence of Diabetes in Nepali-Speaking Bhutanese Americans Living in the Greater Harrisburg Area.

Members of the Nepali-speaking Bhutanese refugee community had resettled in the United States beginning in 2008 after previously being settled in United Nations (UN) refugee camps in Nepal. Due to the recency of their resettlement, there has been little research regarding diabetes in the Nepali-speaking Bhutanese American community. This study sought to identify the prevalence of diabetes in Nepali-speaking Bhutanese Americans living in the Greater Harrisburg Area and whether this community was at a higher risk of developing diabetes due to changes in diet and physical activity lifestyle behaviors. This study was conducted using an anonymous online survey. Anyone over the age of 18 and a self-identified member of the Nepali-speaking Bhutanese American community living in the Greater Harrisburg Area was included, regardless of their diabetes status. This study excluded individuals under the age of 18, those found outside the limits of the targeted region, and those who do not self-identify as members of the Nepali-speaking Bhutanese American community. Through this survey, data regarding demographics (age and gender), length of stay in the US, diabetes status (present or absent), consumption of rice (increased or decreased post-resettlement), and physical activity status (increased or decreased post-resettlement) were collected. The current prevalence of diabetes in this population was compared against the one reported by the CDC before migration and against the prevalence of diabetes in the general population of the United States of America (USA). The association between rice consumption, physical activity, and diabetes was analyzed using the odds ratio. The survey yielded responses from 81 participants. Results showed a 2.29 times higher prevalence of diabetes in the Bhutanese-speaking Nepali population of the Greater Harrisburg Area, Pennsylvania, compared to the general population of the USA. Results indicated a 37 times higher prevalence of diabetes after resettlement in the USA compared to the population's self-reported prevalence before the resettlement. The data showed that increased rice consumption or decreased physical activity alone did not significantly increase the risk of developing diabetes. However, the combination of decreased physical activity and increased rice consumption significantly increased the risk of diabetes, with an odds ratio of 5.94 (CI: 1.27 to 27.56, p-value: 0.01). The higher prevalence of diabetes in this community justifies diabetes education around causes, symptoms, treatments, and preventative healthcare methods. Greater awareness of the issue among the members of this community, as well as their healthcare providers, paves the way for future studies to identify all possible risk factors for diabetes in this community. Once risk factors are identified, early interventions and screening tools can be implemented to mitigate the onset of disease in this population in the future.

Community-Led Health Promotion Groups in a Bhutanese-Nepali Refugee Community.

This practice note reports on the work of the Namaste Community Health Partnership, an academic-community partnership established to address health disparities in a metro-area Bhutanese-Nepali refugee community in the western United States. Partners worked together to develop, implement, and evaluate a culturally-tailored health promotion program where Bhutanese-Nepali individuals led weekly walking groups and shared health promotion information and behavior change tools with community participants. The program was implemented with approximately 70 community members across two metro-area neighborhoods and two adult day care centers serving elders. Evaluation strategies included documenting walk attendance, tracking engagement with health promotion goals, and focus group discussions with program participants. Once enrolled, most participants consistently attended walks and achieved weekly goals-some even increased walking frequency beyond program requirements. Participants provided positive feedback about having a community leader and reported learning new information and enjoying participating with other community members. Challenges and lessons learned included difficulties engaging younger adults from the community, concerns about signing research consent forms, cultural norms discouraging the distribution of individual research participation incentives, variability across groups in preferences for program activities, and barriers to administering survey-based evaluation instruments. This academic-community partnership built capacity in the local Bhutanese-Nepali community, produced culturally relevant health programming, and trained and employed community members as health educators and physical activity leaders. The program resulting from this work has the potential to improve health knowledge and chronic disease prevention practices and ultimately reduce health disparities in an underserved refugee community.

Perceptions of Cervical Cancer Screening, Screening Behavior, and Post-Migration Living Difficulties Among Bhutanese-Nepali Refugee Women in the United States.

Bhutanese-Nepali refugees are one of the largest refugee groups to be resettled in the U.S. in the past decade. Cervical cancer is a leading cause of cancer disparity in this population, yet screening rates are suboptimal. Nepali-speaking interviewers administered a community health needs questionnaire to a convenience sample of Bhutanese-Nepali refugees in a Midwestern city between July to October of 2015. Descriptive statistics were used to describe socio-demographic characteristics, Pap smear beliefs, post-migration living difficulties, and screening status. Differences in Pap test uptake between groups were tested using t test and Chi square statistics. Of the 97 female participants, 44.3% reported ever having had a Pap smear. Screening rates were lowest among women who did not know English at all. Most women had positive perceptions of Pap smears (80%) and 44.4% had received a Pap test recommendation from their healthcare provider, family, or friends. Pap testing was significantly higher among those who had positive perceptions (58.3 vs. 11.1% for women of negative perception, p = 0.01) and those who had received a recommendation (87.5 vs. 18.6% for women who had no recommendations, p < 0.001). Significant predictors of having a Pap smear were having a healthcare provider/family/friends recommendation (OR 65.3, 95% CI 11.4-373.3) and greater number of post-migration living difficulties (OR 1.18, 95% CI 1.02-1.37). The results of this study have important implications for the development of cervical cancer prevention programs targeting Bhutanese-Nepali refugees. Providing cancer prevention interventions early in the resettlement process could impact Pap test uptake in this population.