Migration, health and diabetes mellitus - Studies comparing foreign-and Swedish-born diabetic subjects living in Sweden

Abstract: To study the influence of migration on health in migrant diabetic subjects, foreign-and Swedish-born persons were compared as regards objective and subjectively perceived health in relation to social position, and beliefs about health and illness and their influence on self-care and care-seeking behaviour. Persons (foreign- and Swedish-born) with known diabetes mellitus (DM), aged 16-74 years, were chosen from two different counties in Southern Sweden (n=143/1384; 113/1564), and from a random sample of the Swedish population, the annual Swedish Survey of Living Conditions (n=31/446). They were studied by medical records, clinical examination, standardised and structured interviews. Health care staff in diabetes care (n=149)answered a questionnaire regarding their perceptions of beliefs about health and illness in migrants. Women born in Ex-Yugoslavia and Sweden (n=13/15, 33-73 yr)were interviewed in focus groups. Foreign-born, mainly respondents from European countries, stated poorer subjectively perceived health than Swedish-born subjects. This was more strongly related to socioeconomic factors than country of birth as an indicator of migration experiences. No major differences in objective health (prevalence of DM, glycaemic control and complications) were found. Glycaemic control was related to low social position irrespective of origin. Indicators of low social position were risk factors of self-reported DM. Migrants, especially Yugoslavians and non-Europeans, were perceived to differ from Swedes in being less knowledgeable about bodily function and diabetes. Yugoslavian females gave less concrete examples of beliefs about health and illness, focused on migratory experiences, enjoyed life by making deviations from dietary advice and retaining former traditions, were less inclined to self-monitoring and preventive foot care, expressed dependency on health care staff and discussed the influence of supernatural forces. Thus, beliefs about health and illness differ between migrant and Swedish-born diabetic subjects and are essential for self-care practice and care-seeking behaviour. Migrational background affects health, and socioeconomic circumstances and cultural beliefs are of crucial importance in the management of DM.