Does Medicine Care About Your Culture?
Chinese Americans suffer from type 2 diabetes at more than twice the rate of white Americans, even though they receive the same treatments. Kevin Chun, a USF psychology professor with roots in San Francisco's Chinatown, has dedicated years of research to finding out why and what can be done about it. Chun’s diabetes management approach — with its culture-appropriate focus — has become a model for minorities across the nation.
USF News asked Chun about cultural diversity in healthcare.
Why study type 2 diabetes in Chinese Americans?
Chinese Americans have a 7.4 percent prevalence rate of type 2 diabetes,
compared to 2.9 percent for non-Hispanic whites. Yet, the diabetes management needs of this ethnic community have not been fully addressed.
What did your research reveal?
The current ways of managing diabetes are mainly designed for European Americans and may not be applicable to Chinese Americans. For example, dietary restrictions: standard recommendations do not consider that for Chinese Americans, certain foods have great cultural significance and are important to maintain social relations. So not eating what family members have cooked, giving up cultural foods such as white rice, and saying no to family and social events that revolve around eating causes patients a lot of stress. And while expressing anger as a result of stress is easily forgiven in American culture, that is not the case in Chinese families — which may frown upon expressing negative emotions that disrupt family relations.
How does your research address these challenges?
My research colleagues at UC San Francisco and I want patients to be able to respond to these problems without feeling undue stress — so we use cognitive behavioral therapy (CBT) to help them build problem-solving skills and develop new ways of thinking about their diabetes management challenges. We take situations that they have encountered and practice how to respond using role-plays and problem-solving strategies: How to deal with family and social pressure to eat Chinese dishes? How to not upset the family by having meals on their own? How to communicate their distress with family members and health care provider?
Has the approach worked?
Yes. More than 140 diabetes patients from San Francisco's Chinatown completed our study in 2013, and two months after the behavioral trainings they reported better diabetes knowledge, more emotional support from family, and less diabetes distress, among other positive outcomes.
What's this mean for Chinese Americans across the country?
Our diabetes management study was one of the first to show CBT’s effectiveness with Chinese Americans. We also culturally-adapted and tested a diabetes prevention program for Chinese Americans that’s currently being considered for widespread distribution to Medicare providers across the nation. We hope that more health care providers nationwide will begin to use our culturally-appropriate approach and, as a result, that Chinese Americans’ diabetes management and overall health improves.
Do USF students study culturally-appropriate treatments?
Yes, definitely. Students learn that psychological functioning occurs in a real cultural context, not in a vacuum. We study successful examples of culturally-appropriate treatments, and a few of my students even help analyze research data — which prepares them for graduate school, post-doc work, and eventually, careers.