Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study

OBJECTIVE: The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. STUDY SETTING AND DESIGN: Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. PARTICIPANTS: A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. DATA COLLECTION: Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. PRINCIPAL FINDINGS: Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. CONCLUSIONS: Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control.

Co-encapsulation and characterisation of omega-3 fatty acids and probiotic bacteria in whey protein isolate-gum Arabic complex coacervates

Omega-3 fatty acids and probiotic bacteria were co-encapsulated in a single whey protein isolate (WPI)-gum Arabic (GA) complex coacervate microcapsule. Tuna oil (O) and Lactobacillus casei 431 (P) were used as models of omega-3 and probiotic bacteria, respectively. The co-microcapsules (WPI-P-O-GA) and L.casei containing microcapsules (WPI-P-GA) were converted into powder by using spray and freeze drying. The viability of L.casei was significantly higher in WPI-P-O-GA co-microcapsules than in WPI-P-GA. The oxidative stability of tuna oil was significantly higher in spray dried co-capsules than in freeze dried ones.

The relationships between illness and treatment perceptions with adherence to diabetes self-care: A comparison between Arabic-speaking migrants and Caucasian English-speaking patients

Aims
To compare illness and treatment perceptions between Arabic-speaking immigrants and Caucasian English-speaking people with type 2 diabetes, and explore the relationships between these beliefs and adherence to self-care activities.
Methods

A cross-sectional study was conducted in healthcare settings with large Arabic populations in metropolitan and rural Victoria, Australia. Adherence to self-care activities, illness and treatment perceptions, and clinical data were recorded. Bivariate associations for continuous normally distributed variables were tested with Pearson's correlation. Non-parametric data were tested using Spearman's rank correlation coefficient.
Results

701 participants were recruited; 392 Arabic-speaking participants (ASPs) and 309 English-speaking participants (ESPs). There were significant relationships between participants’ illness and treatment perceptions and adherence to diabetes self-care activities. ASPs’ negative beliefs about diabetes were strongly and significantly correlated with poorer adherence to diet recommendations, exercise, blood glucose testing and foot care. ASPs were significantly less adherent to all aspects of diabetes self-care compared with ESPs: dietary behaviours (P = <0.01; 95% confidence interval (CI) = −1.17, −0.84), exercise and physical activity (P = <0.001, 95% CI −1.14, −0.61), blood glucose testing (P = <0.001) and foot-care (P = <0.001). 52.8% of ASPs were sceptical about prescribed diabetes treatment compared with only 11.2% of the ESPs. 88.3% of ASPs were non-adherent to prescribed medication, compared with 45.1% of ESPs.

Conclusions
Arabic-speaking migrants’ illness and treatment perceptions were significantly different from the English-speaking group. There is a pressing need to develop new innovative interventions that deliver much-needed improvements in adherence to self-care activities and key health outcomes.

Innovation in language education: enriching Arabic language learner experiences and proficiency in 2D and 3D environments.

Abstract:-Global language and cultural communicative competency is an ever increasing requirement in our connected world. Learners of Arabic at the only five Australian universities where Arabic is taught have access to predominantly on-campus delivery modes. One of the main challenges learners face when learning another language (L2) in an academic setting in countries where that language is not actively used – so little L2 exposure – is that it is harder to provide meaningful contexts for learning. This restriction in L2 exposure in the formal academic framework is due to the limited face-to-face learning time and, more significantly, is compounded by lack of exposure to the language‟s authentic use settings. Students are often isolated from the target language‟s authentic discourse communities and native speakers. This situation is exacerbated for Cloud (online) students, studying in relative isolation. All of these factors make developing communicative oral fluency in Modern Standard Arabic (MSA) moredifficult and challenging for many learners. This paper will discuss two innovative approaches used at Deakin University in Melbourne, Australia to enable learners of Arabic at Deakin University to practice their developing skills by listening, practising, and experiencing directly how the language is used outside the classroom boundaries as well as allow learners to develop their oral and cultural communicative competency by engaging them in simulating and evolving authentic language scenarios with native Arabic speakers through the Virtual World (VW).

Tools for enhancing oral proficiency and cultural understanding in teaching Arabic online to non-native speakers

One of the main challenges learners of Arabic as a foreign language face in Australia is the lack of opportunities to practice the language with native speakers of Arabic outside the classroom boundaries to enhance their language skills in general and their oral proficiency in particular. Learners have so little exposure to Arabic outside the classroom. This restriction in L2 exposure in the formal academic framework is due to the limited face-to-face learning time and, more significantly, is compounded by lack of exposure to the language’s authentic use settings. Students are often isolated from the target language’s authentic discourse communities and native speakers. This situation is exacerbated for Cloud (online) students studying in relative isolation. All of these factors make developing communicative oral fluency in Modern Standard Arabic (MSA) more difficult and challenging for many learners, particularly for Cloud learners. Deakin University is the only university in Australia that offers Arabic in both Campus and Cloud modes of delivery. This paper discusses an innovative approach used at Deakin University to enable online learners of Arabic to practice their developing skills by listening, practicing, and experiencing directly how the language is used outside the classroom boundaries. In addition to providing Cloud learners with an Arabic online environment rich with interactive opportunities to practice the language, it was also necessary to provide the learners with tools such as the virtual classrooms, chat rooms, discussion forums and social media language partner programs, to practice their oral fluency and enrich their learning experience.

Race, identity and education achievements among Arab-Australian students

This paper discusses the challenge of managing cultural diversity in secondary schools, focusing on key structural, ideological, cultural, attitudinal and identity factors affecting the educational experiences and outcomes of Australian students from Arabic-speaking background (ASB). Recent research indicates that there are complex processes at play that hinder the ability of non English-speaking background (NESB) students to access constructive and meaningful education, and that such processes need further systematic investigation. It has also been argued that Australian schools are failing the test of social equity and that the dominant approach to curriculum and pedagogy does not meet the needs of the growing numbers of students from divergent cultural and socio-economic backgrounds. This paper focuses on identifying the social, cultural and attitudinal factors that affect the educational achievements of ASB students within a broad multidimensional approach to multicultural education. By linking thorough empirical research and innovative theory with practical, tested plans of action, this study proposes an in-principled approach to multicultural education that is extendable to a variety of schooling contexts while retaining its core focus on effecting positive learning outcomes. The key objectives of the larger study upon which this paper is based are to (a) address the disadvantages and barriers faced by NESB young people, particularly ASB young people, in achieving positive educational outcomes; (2) increase their chances for better life opportunities and self fulfilment; and (3) develop a good practice model for diversity management in Victorian schools. This latter objective will complement Victorian Government policies on cultural diversity and multicultural education.

Structural deficiency or cultural racism: the educational and social experiences of Arab-Australian youth

This paper discusses the cultural, attitudinal and structural factors that impact upon the social experiences and educational achievements of Arabic-speaking background (ASB) students in three Melbourne secondary schools with high levels of cultural and linguistic diversity. The paper makes the case for and then outlines a multidimensional approach to multicultural education to better integrate ASB students and their families into the schooling environment. Key strategies developed and tested include a model of school-community partnership, online and interactive teacher support material (TSM) as well as on-going teacher professional development workshops on reflexive approaches to cultural diversity and intercultural tension.

Core affect and subjective wellbeing: a rebuttal to Moum and Land

This paper is a rebuttal to the reviews of Moum and Land. Publication has been facilitated by Journal policy (see Instructions to authors ‘Procedure when the authors and reviewers disagree’ on the Journal website) which details the procedure to be followed in the case of disputed manuscripts. Our reply is in two parts. The first concerns issues of theory and the second issues of methodology. Each point of critique raised by the reviewers has been answered and shown either to be false or irrelevant. We contend that our original conclusion still stands. Subjective wellbeing is dominated by Core Affect.

A cross-continental examination and comparison of descriptive criteria in marketing journals-AMJ, EJM and JM

The objective is to perform a cross-continental examination and comparison of non-traditional descriptive criteria in a selection of leading academic journals in marketing. The sample of journals is restricted to the examination and comparison of three academic journals in marketing. The journal sample consists of the Australasian Marketing Journal (AMJ), the European Journal of Marketing (EJM) and the Journal of Marketing (JM). Empirical research manuscripts dominate in the selected marketing journals. In addition, in the selected journals regular issues dominate in favour of special issues. The descriptive criteria examined and compared in AMJ, EJM and JM are based upon the content analysis of 811 manuscripts published during a six-year period, namely 2000-2005. Manuscripts of types other than empirical research, such as general reviews, literature reviews, conceptual papers, commentaries and book reviews are less likely to get published. Special issues or special sections are less frequent in these journals. This may lead to the situation that specialized journals in sub-areas of marketing may provide better and more comprehensive leading edge coverage and knowledge. The insights provided are in particular valuable for those scholars that do not usually get involved in academic publishing and consequently have a limited understanding and experience of the publication arena of manuscripts in leading academic journals. These insights also will be informative for more experienced academic publishers as they highlight certain characteristics of these journals that enlighten one as to the journals that one should target for publication and the difficulty, just on a numbers basis alone, of getting published in one of these three journals. The principal contribution of this research is the examination and comparison of descriptive criteria in AMJ, EJM and JM – a cross-continental sample of journals and criteria that have not been explored or reported previously in literature.

Language processing and acquisition in languages of Semitic, root-based, morphology / Joseph Shimron

This book addresses a fundamental question in the morphological analysis and representation of Semitic languages—namely, whether Semitic word morphology is root based or word based. As Shimron suggests, “there are reasons to view the templates, not the roots, as the more influential factor in determining Semitic morphology” (p. 5). Yet, as others would argue, there are reasons not to disregard the root-based hypothesis altogether. In the case of Arabic morphology, for example, verbal forms inherently contain three nonlinear levels: the consonantal root, the vowel pattern, and the templatic prosody. This nonlinear feature provided a perfect illustration of what has become termed in the literature as root-and-patterns morphology (McCarthy & Prince, 1986, 1990).

Gustav Holst and British Music Society of Victoria collections at the State Library of Victoria

The paper presents a content-based evaluation, tracing the historical background of two heritage music collections at the State Library of Victoria (Melbourne, Australia).  In the case of the Gustav Holst and the British Music Society of Victoria Collections, history and content intertwine for the reason that both collections were initiated at the same time and by the same visionary power. During the early 1930s Louise Hanson-Dyer, a patron of Gustav Holst, issued a complete catalogue of the composer’s works and donated to the State Library of Victoria the first batch of Holst scores. This was to be the initial installment of a complete collection of published British music, which, however, was stopped due to duty tax complications. At the same time, the British Music Society of Victoria, founded by Louise Hanson-Dyer in 1921, maintained the first open library of chamber music in Australia. The BMS of Victoria Collection came to the State Library of Victoria in the 1980s. The most valuable materials in the collection are manuscripts of Australian twentieth century works, concert programs and first publications of British music from the 1920s and 1930s, which also supplement the Gustav Holst Collection. The collections are valuable reference and research collections, which document musical taste and music-making in Melbourne from 1920s well into the 1970s. The collections are also sources for studies into Louise Hanson-Dyer’s gift in collection development and her efforts to raise the professional standards of music performance in Melbourne and Australia.

Relational bonds and loyalty : the bonds that tie

This paper explores the effect of financial, social and structural bonds on the loyalty of Arabic five star hotel guests. Three different measures of loyalty are used; attitudinal, behavioural and combined to identify how the three relational bonds affect loyalty. The results show that social and structural bonds increase all types of loyalty whereas financial bonds only increase attitudinal and combined loyalty. It is also found that bonds are perceived to be more important for high-loyal consumers as compared to low-loyal consumers. This all suggests that firms seeking to increase loyalty may need different strategies depending on the consumers being targeted.

A cross-cultural examination of barriers to social inclusion for children : a qualitative study using child-centred methods

Social exclusion is a risk factor for mental health problems. This study aims to identify the factors that contribute to social exclusion for children from several cultural backgrounds, living in low-socioeconomic status (SES) areas. Children from English, Chinese and Arabic speaking backgrounds participated in semi-structured interviews. They were asked questions around three prominent themes of social exclusion: exclusion from school, social activities and social networks. Children from English and Chinese speaking backgrounds experienced exclusion at school, from social activities or in social networks. The major barriers to social inclusion, which differed across cultural groups, included bullying, time constraints, economic resources and parental permission. Although money is a barrier to social inclusion, there are several other barriers that need to be considered, such as bullying, time and parental permission, and they may differ by culture. Mental health promotion programmes in schools and communities need to address these barriers in a culturally appropriate manner.

The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes

Background: Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.

Methods: Four focus groups were conducted with people with type 2 diabetes:  two with English speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description.

Results: We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages.

Conclusion: Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each  person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals'  support for self-care strategies will be more congruent with patients' expectations if they explore each person's social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes.

Women's silence : in the space of words and images

My thesis is made up of words and images. This study investigates the way in which silence operates productively within and between the two modes of communication. I suggest that in the process of changing words into images or scripto-visual art-practice, the silence in women's lives can be articulated. I argue that women draw on the generative qualities of silence to create forms of speech that override the cultural constructions of gender which have placed them within the space of ‘mute’ silence. To gain an historical perspective of this practice by women, I consider the lives of medieval nuns within religious enclosure and their work with words and images in the illuminated manuscript. I make a comparative study of original illuminated manuscripts, focussing mainly on visual language and locating aspects of the work closest to my own art-practice: the visual treatment of the space and inter-textual components of the page or folio. This project does not include an examination of miniatures or historiated initials. Rather, its aim is to identify and compare the use of other aesthetic devices available to the medieval scribe/artist through which they might have interacted with the text. I suggest links between verbal and visual performances of language and the repetition, or copying of texts by medieval nuns, as a means of female embodiment of words and their spaces. From the outcomes of my studio investigations and my consideration of other contemporary feminist art practices, I demonstrate how women artists may ‘re-write’ the text and ‘speak’ their silence through visual language and the acts of writing, drawing and painting the words of others. Through my engagement with feminist critical theory, the work of medieval scholars, original illuminated manuscripts and my studio research, I propose that scripto-visual practice remains particularly significant for women despite the differences between the medieval period and our own. As a generative practice, it negotiates some of the societal constraints on women's speech and visibility, because its language is ‘silent and disembodied’ from the image of woman constructed by male discourse. It is a form of speech that acknowledges as it defies the social and cultural conditions that shaped its necessity, articulating an alternative voice of women in the space of words and images.