Perceptions and experiences of taking oral hypoglycaemic agents among people of Pakistani and Indian origin : qualitative study

Objective:  To explore British Pakistani and British Indian patients’ perceptions and experiences of taking oral hypoglycaemic agents (OHAs).
Design : Observational cross sectional study using in-depth interviews in English or Punjabi.
Setting and participants : 32 patients of Pakistani and Indian origin with type 2 diabetes, recruited from primary care and community sources in Edinburgh, Scotland.
Results : Respondents reported complex and ambivalent views about OHAs, which reflected their ambivalent attitudes towards Western drugs in general. Respondents considered OHAs to be an important part of the diabetic regimen because they perceived British healthcare professionals to be competent and trustworthy prescribers, and they considered the medicines available in Britain to be superior to those on the Indian subcontinent. Despite this, some respondents made deliberate efforts to reduce their tablet intake without being advised to do so. Reasons for this included perceptions that drugs worked by providing relief of symptoms and concerns that OHAs could be detrimental to health if taken for long periods, in conjunction with other drugs, or without traditional foods.
Conclusions : British Pakistani and Indian patients’ perceptions of their OHAs may partly derive from popular ideas about drugs on the Indian subcontinent. Cultural factors need to be understood and taken into consideration to ensure that these patients are given appropriate advice and to avoid unnecessary changes to prescriptions.

Diabetes service provision : a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.

Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews.

Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly.

Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability.

‘I can’t do any serious exercise’ : barriers to physical activity amongst people of Pakistani and Indian origin with Type 2 diabetes

Type 2 diabetes is at least 4 times more common among British South Asians than in the general population. South Asians also have a higher risk of diabetic complications, a situation which has been linked to low levels of physical activity observed amongst this group. Little is known about the factors and considerations which prohibit and/or facilitate physical activity amongst South Asians. This qualitative study explored Pakistani (n = 23) and Indian (n = 9) patients' perceptions and experiences of undertaking physical activity as part of their diabetes care. Although respondents reported an awareness of the need to undertake physical activity, few had put this lifestyle advice into practice. For many, practical considerations, such as lack of time, were interwoven with cultural norms and social expectations. Whilst respondents reported health problems which could make physical activity difficult, these were reinforced by their perceptions and understandings of their diabetes, and its impact upon their future health. Education may play a role in physical activity promotion; however, health promoters may need to work with, rather than against, cultural norms and individual perceptions. We recommend a realistic and culturally sensitive approach, which identifies and capitalizes on the kinds of activities patients already do in their everyday lives.

‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts.

Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones.

Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be 'dangerous' and detrimental to their diabetes control. Respondents described such foods as 'strength-giving', and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines.

Conclusions. Perceptions that South Asian foodstuffs necessarily comprise 'risky' options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.

Customer relationship management in banks with special reference to Bangladesh

Customer-banker relational behavior is dynamic and fast-changing and better interpersonal relationships tend to be characterized by their quality. Banks in Bangladesh are functioning increasingly under the competitive pressures originating from the banking system from non-banking institutions as well as from the domestic and international capital markets. In order to expand banking business, as well as sustain it in the long run, it has now become essential for banks to focus on developing long-term relationships with their customers. One facet of the efficient management of banks is the matching of customers' needs and banking products. Banks, when creating new products, should take into consideration their customers' needs informed by market research programs. In this paper we examine whether banking products in Bangladesh address customers' needs.

The ascent of asymmetric risk in information security: an initial evaluation

Dramatic changes in the information security risk landscape over several decades have not yet been matched by similar changes in organizational information security which is still mainly based on a mindset that security is achieved through extensive preventive controls. As a result, maintenance cost of information security is increasing rapidly, but this increased expenditure has not really made an attack more difficult. The opposite seems to be true, information security attacks have become easier to perpetrate and appear more like information warfare tactics. At the same time, the damage caused by a successful attack has increased significantly and may sometimes become critical to an organization. In this paper we evaluate one particular extremely asymmetric risk where a strongly motivated attacker unleashes a prolonged attack on an organization with the aim to do maximum damage, and suggest that the probability of such an attack is increasing. We discuss how preventive controls are unlikely to ever be effective against such an attack and propose more advanced strategies that aim to limit the damage when such an attack occurs. One crucial lesson to be learned for those organizations that are dependant on their information security, such as critical infrastructure organizations, is the need to deny motivated attackers access to any information about the success of their attack. Successful deception in this area is likely to significantly reduce any potential escalation of the incident.

NGO's use of the media to create changes in corporate activities and accountabilities : evidence from a developing country

This paper investigates how social and environmental NGOs use the news media to create changes in the operations and associated accountabilities of multinational companies operating in, or sourcing products from, a developing country. In this research, we explicitly seek the views of senior officers from global and local NGOs operating in Bangladesh, as well as the views of journalists from major global and local news media organisations. Our results show that social and environmental NGOs strategically use the news media to effect change in the operating and disclosure policies pertaining to corporate labour practices. More particularly, both the NGOs and the news media representatives stated that NGOs would be relatively powerless to create change without media coverage. Our results also show that the media agenda has been responsible for creating improvements in working condition within Bangladesh, but further improvements are necessary. This is the first known study to specifically address the joint role of NGOs and the news media in creating changes in the social and environmental operating and disclosure practices of organisations operating in developing countries.

Grameen Bank's social performance disclosure : responding to a negative assessment by Wall Street Journal in late 2001

Purpose: The aim of this paper is to establish a linkage between negative global media news towards Grameen Bank (GB), the largest microfinance organisation in the developing world, and the extent and type of annual report social performance disclosures by GB, over the nine-year period 1997-2005.

Design/methodology/approach: Content analysis instruments are utilised to analyse GB annual report social disclosure.

Findings: The study finds that GB's community poverty alleviation disclosures account for the highest proportion of total social disclosures in the period 1997-2005. The results of this study are particularly significant in relation to poverty alleviation – the issue attracting severe criticism from the Wall Street Journal (WSJ?) late in 2001. The community poverty alleviation disclosures by GB are significantly greater over the four years following the negative news in the WSJ than in the four years before. The results suggest that GB responds to a negative media story or legitimacy threatening news via annual report social disclosures in an attempt to re-establish its legitimacy.

Originality/value: This paper contributes to the literature because in the past there has been no research published linking global media attention to the social disclosure practices of major organisations in developing countries.

Motivations for an organisation within a developing country to report social responsibility information

Purpose – The aim of the paper is to describe and explain, using a combination of interviews and content analysis, the social and environmental reporting practices of a major garment export organisation within a developing country.

Design/methodology/approach – Senior executives from a major organisation in Bangladesh are interviewed to determine the pressures being exerted on them in terms of their social and environmental performance. The perceptions of pressures are then used to explain – via content analysis – changing social and environmental disclosure practices.

Findings – The results show that particular stakeholder groups have, since the early 1990s, placed pressure on the Bangladeshi clothing industry in terms of its social performance. This pressure, which is also directly related to the expectations of the global community, in turn drives the industry's social policies and related disclosure practices.

Research limitations/implications – The findings show that, within the context of a developing country, unless we consider the managers' perceptions about the social and environmental expectations being imposed upon them by powerful stakeholder groups then we will be unable to understand organisational disclosure practices.

Originality/value – This paper is the first known paper to interview managers from a large organisation in a developing country about changing stakeholder expectations and then link these changing expectations to annual report disclosures across an extended period of analysis.

Media pressures and corporate disclosure of social responsibility performance : a case study of two global clothing and sports retail companies

This paper investigates the social and environmental disclosure practices of two large multi-national companies, specifically Nike and Hennes and Mauritz. Utilising a joint consideration of legitimacy theory and media agenda setting theory, we investigate the linkage between negative media attention, and positive corporate social and environmental disclosures. Our results generally support a view that for those issues attracting the greatest amount of negative media attention, corporations react by providing positive social and environmental disclosures. The results were particularly significant in relation to labour practices in developing countries – the issue attracting the greatest amount of negative media attention for the companies in question.

Undergraduate public relations education in Malaysia : a case study

Public relations worldwide often restricts itself to the bounds of an American context. This thesis argues that Malaysian public relations education and its professional practice should create its own unique model of public relations education and its professional practice due to its differences in politics, culture and the media environment.