Tag Archives: Research

Talanoa approach supports long-term change for Pasifika women with diabetes

Type 2 Diabetes is a significant public health problem and Australian Pacific Islander women and their communities are experiencing a higher burden of morbidity and mortality from the disease. Despite the higher burden, there are few initiatives that are culturally tailored to improve prevention and management.

We spoke to Women’s Wellness Research Collaborative member Dr Heena Akbar from the University of Queensland about using talanoa, a community-based research methodology, to build capacity with Australian Pacific Islander women in Queensland to develop culturally relevant methods of information sharing and knowledge building to improve health outcomes for women with Type 2 Diabetes.

Can you tell us more about this project and how it came about?

The Pasifika Women’s Diabetes Wellness Program was borne out of wanting to look at diabetes in the Pasifika (Pacific) context because, as a person from Fiji, we are often faced with an increased risk of type 2 diabetes in our communities, both in the islands but also in Australia. Here in Australia, we don’t have recent data, which makes it challenging for our communities to address this important issue.

I started my PhD in 2013 after talking to our community elders and members about how we might address this problem in a culturally appropriate and strength-based way. My PhD looked at “Socio-Cultural Context of Managing Type 2 Diabetes in Australian Pacific Islander Women Living in Queensland” where through participatory action research and embedding the Talanoa Pacific methods – story telling – we aimed to understand how our women who already have type 2 diabetes were looking after themselves and managing their diabetes within their family and community context.

The focus of this research was about working together with our women in the Māori and Pasifika community to develop awareness around diabetes and to promote diabetes prevention and management for our Pasifika community. We worked closely with our Pasifika communities to host three diabetes health forums (during my PhD) that provided diabetes education, promoted awareness around chronic conditions and undertook health screening for our people within a culturally safe community space.

Community led initiatives have a far more powerful impact on change. This is partly because we frame our work through cultural safety principles and cultural values such as identity, respect, reciprocity, spirituality, family and community, which are pertinent to Māori and Pasifika communities and our ways of knowing, being and doing.

Can you tell us more about the community-academic partnership and the value of this to the project?

Community-academia partnership is really important, particularly when we want to build a culturally responsive research path for academia and community collaboration.

Strong partnerships are also very important if we want to make a positive contribution towards influencing long-term health behaviours.

Our work is largely a partnership with the Pasifika Women’s Alliance Inc. (PWA), a culturally diverse network of women from across Oceania that seeks to build and strengthen a Queensland sisterhood of Pacific Islander women and to raise awareness of members as to their rights and responsibilities as citizens and encourages their participation in all aspects of community life. A large part of this is ensuring that our women are aware of their health and includes promoting healthier and stronger families through projects like the Pasifika Women’s Diabetes Wellness Program.

What is the Talanoa Framework and how was it used in your approach?

‘Talanoa’ frames how we talk to each other. Talanoa – is a Pasifika way of having conversations and dialogues between people and relies heavily on building and maintaining relationships. Talanoa with elders and members of the Pasifika communities are critical in community engagement and in the development of diabetes research protocols to ensure long-term benefits and change in health inequities.

In the Pasifika Diabetes Wellness context, it is important for us to build personal connections with our women and communities – using our Pasifika way – ‘Talanoa’ – which means that our women own the process of collecting the information that is meaningful to them.

It is also about acknowledging our ancestors, our culture, where we come from and giving that respect to our people. Trust, reciprocity, spirituality, nurturing is all part of our collective Pacific culture. Embracing these in the research processes is imperative to working respectfully with Pacific peoples and is very important in our understanding of our health and wellbeing.

We have approached this research using talanoa as a cultural framework and taking this approach has certainly made the research and collecting information more meaningful for our women and community.

What have been some of the notable outcomes of this project to date – for the community and academia?

Our research and this project have built strong partnerships with key stakeholders, including Griffith University, Diabetes Queensland, The Good Start Program for Māori and Pacific Islander Communities, and many community groups who are represented by our PWA members. PWA have been pivotal in creating a safe space for our women to engage in this research process and also to ensuring that the research mutually benefited our Pacific communities.

Through these partnerships, we have led three very significant community summits – the Pacific women’s diabetes health forums, in 2013 and 2014, and community-led Pasifika diabetes health from in 2016.

We have also worked very closely with our Pasifika communities and PWA to provide a culturally-safe community space to run diabetes education sessions, undertake health screening for our people and conduct Talanoa discussions to collect information with our people. More than 90 Queensland University of Technology students have also conducted community placements in these health forums.

This framework has been used worldwide amongst Indigenous peoples and is notably a very successful model because it is driven by the people and for the people using their own cultural frameworks.

We have also been instrumental in building individual as well as organisational capacity for our women to address health in the community. We developed a teaching module which is currently being used by the Federal Government to train and educate health providers in how to work with culturally and linguistically diverse and Indigenous communities such as ours.

We have presented in several national and international Health conferences including NZ, Hawaii, Canada, Cairns and here in Brisbane and were awarded two grants to run the Diabetes health forums and carry out the research (through Diabetes Queensland and QUT Engagement and Innovation grant).

Future grants have allowed us to develop the Pasifika Women’s Diabetes Wellness Program and the most recent funding will allow us to trial this program.

For more information about the Pasifika Women’s Diabetes Program, visit www.dawncomplete.org.au.

Dr Heena Akbar is a Lecturer in Public Health within the Faculty of Medicine at the University of Queensland and an Adjunct Fellow at the Queensland University of Technology.

Life after cancer treatment – bridging the wellness gap

With the launch of the Women’s Wellness podcast, we spoke to Professor Sandie McCarthy from the University of Queensland about the Women’s Wellness after Cancer Program; its origins, its purpose and how lifestyle interventions can improve post-treatment experiences.

Why do we need a program for Women’s Wellness after Cancer?

The catalyst for the Women’s Wellness after Cancer program happened when I was working as a chemotherapy nurse many years ago. I would provide care for women over an intensive period of time and then never see them again and would often wonder what happened to these women after their cancer treatment. One day I ran into a lady I had helped treat and she looked really unwell. I asked how she was doing and she said that while the cancer was gone, she was left with heart failure. And this was many years before we fully understood the many side effects cancer treatments have.

So from that moment on, I started researching what happened to these women and was quite devastated as a clinician as to the after effects, and long term side effects, of the treatments that I had been administering. In those days these weren’t really well recognised – they are now.

Today we also understand that if we implement certain lifestyle changes, both during and after treatment, we can often prevent those side effects from happening or moderate their effects. And this was ultimately the impetus for the development of the Women’s Wellness after Cancer Program.

What sort of lifestyle modifications can women put in place if they are undergoing cancer treatment or completed treatment?

There’s a raft of different lifestyle changes and modifications women can make after cancer treatment but what ultimately underpins success for women’s wellness is good psycho-social support. We’ve got to wrap these women in a support blanket, because essentially when they’ve left cancer treatment, they’re left to recover on their own – they are considered well. Many women don’t know what lifestyle changes or strategies to use to change their treatment outcomes and post treatment experience.

What we’re really focused on with the Women’s Wellness after Cancer Program is quality of life and function for these women, and how lifestyle modifications can enhance that. This includes things like lots of movement, minimising alcohol wherever possible, eating a really healthy diet, getting enough sleep, minimising the effects of early onset menopause that is brought on by many breast and gynecological cancer treatments and minimising psycho-social distress.

So what can women expect from the Women’s Wellness after Cancer Program?

The Women’s Wellness after Cancer Program is a 12-week, very supportive, lifestyle management intervention program, where we give a lot of clinical and psycho-social support to women. Throughout the 12-weeks we guide them through the lifestyle changes that they need to make in a very evidence-based way. So things like, what’s the best way to get your body moving, particularly when you’ve got pain or neuropathy; what’s the best diet to have – women who have undergone breast cancer treatment, for example, often come out of the treatment weighing a lot more than when they went in due to the nature of the drugs, so we support women to lose weight in the best and safest way. We also help women work through how best to manage the hot flushes and the sleeplessness that is a result of treatment-induced menopause and how to manage lymphedema, which is the swelling of limbs that can occur after some surgeries.

These are just some of the ways we support women during the 12-week program and we’ve had a great deal of success with the program. Since then, we’ve moved onto younger women with the Younger Women’s Wellness after Cancer Program because they have very specific issues around sexual function, fertility, social support and how to bring up young children in the context of this condition, for example.

What’s next for Women’s Wellness?

We’ve expanded the Younger Women’s Wellness after Cancer Program into New Zealand and Hong Kong and next year we’ll be developing a whole new program with Canteen for younger women and young men between the ages of 15 and 24. We’re developing a lifestyle intervention for them, which will be totally delivered by telehealth and designed by the participants – they’ve even designed the logos for the program.

We’ll also be moving into addressing issues like body image in our Programs, because a lot of cancer surgeries, chemotherapy and radiotherapy result in a lot of bodily alteration that can be quite difficult to deal with, from the removal of breasts, lymphedema and stomas on the outside of your stomach rather than normal bowel function, for example. So we’re considering how to support women to develop a ‘normal’ lifestyle in the context of bodily alterations that come as a result of cancer treatments.

For more information about the Women’s Wellness after Cancer Program and other wellness programs, visit www.dawncomplete.org.au 

Janine Porter-Steele

Janine is The Clinical Nurse Manager of the Wesley Hospital Choices Cancer Support Centre in Brisbane.  The centre offers support, sharing and information for women, men and their families affected by a diagnosis of cancer. For many years Janine has also been actively involved with the Women’s Wellness Research Programs as manager,  delivering the programs, supporting the development of resources, and co-writing a number of the journals.

Janine undertook much of her training in the UK as a registered nurse, midwife, health visitor and family planning nurse. She completed a Bachelor of Nursing at QUT, a Masters in Nursing Leadership at ACU and she is also Breast Care and Women’s Health Nurse. Janine believes very strongly in providing interdisciplinary and comprehensive support for people affected by a diagnosis and treatment of cancer and has a particular interest in younger, midlife and older women’s health. Janine completed her PhD studies in the area of cancer and sexuality linked with the Women’s Wellness after Cancer Program (WWACP). Her particular focus is in managing menopause, sexuality, body image and depression issues for women.

Lately, Janine has been working with Auckland University and the University of Queensland to deliver a program as part of a research trial providing a Women’s Wellness Program for young women in New Zealand  (NZ) diagnosed with breast cancer. She and the Women’s Wellness team have also been recipients of a grant from Wesley Medical Research. They are using this to replicate the NZ feasibility trial with young women diagnosed with breast cancer in Australia.

In her spare time Janine likes spending time with family and friends. She enjoys walking the local bush tracks in the area. Her favourite relaxation is wandering along the beach in Northern New South Wales and kayaking the rivers down there.

Leonie Young

We hear stories all the time about people diagnosed with cancer but when it becomes personal we’re never prepared.  Somehow, we seem to think we’re different and these things happen to other people.  Well I learned otherwise.  Cancer is what opened up another world and changed so much about who I thought I was.

Breast cancer was totally unexpected especially as I was only 32 years old.  I was busy enjoying being a mother to my two small daughters.  I certainly wasn’t ready to die, although like most people diagnosed with cancer, this is what I thought.

Just hearing the words You have cancer can be a devastating experience people usually remember for the rest of their lives long after they have forgotten all the details of medical treatment and tests that followed those words.

Often people are so frightened by the word “cancer” they hear nothing else.  Interestingly, hearing the diagnosis may actually be more traumatic for some, regardless of their diagnosis. That’s what having a cancer diagnosis is like – people aren’t necessarily brave or especially wonderful in what they do, they just do what they have to do to survive because there’s really no other choice.

My world soon changed to the previously unknown one of tests, surgery, and chemotherapy.  Cancer treatments aim to save lives but in doing so, they often bring life-changing side-effects.   I eventually found ways to make meaning of what I had been through  and found myself being involved with many aspects of cancer consumer advocacy, support, training, and mentoring.  I became interested in research because I believe evidence based practice is the only way we will see change and I have  been able to work along-side researchers  providing input from my personal experience as they develop their research projects.

Likewise, in my work at the Wesley Hospital Choices Cancer Support Centre (Choices) I help support people diagnosed with cancer from the perspective of someone who has “been there” and now with my work and through initiatives like the Women’s Wellness  Programs and the Younger Women’s Wellness After Cancer Program, this support is able to continue in a very rewarding way.

I’ve survived to see my daughters grow up, get married, and have children.  I have to confess I’m torn between wanting to stay young and knowing that growing older is a privilege many women still don’t have.  When I was that young woman back then I really wanted to be where I am today so I do try really hard to embrace the ever increasing grey hair and consequent extra trips to the hairdresser and wrinkles and all the other things that come with age.

Over time I learned to respect cancer, not fear it.  I discovered the power of the lived experience, the value of peer support, and about how I could make a difference.

I want breast cancer to go away so my daughters and grandchildren – and your children, grandchildren, sisters, mothers, friends can live without the fear of breast cancer.

Magnesium

Magnesium Deficiency

This information has been summarized from a discussion by George. D. Lundberg MD (in medscape.com May 2015)

Dr Lundberg says Magnesium is an essential mineral that has significance in multiple regulatory enzyme systems controlling, bone, muscle, nerve, protein, DNA, glucose and energy metabolism.  He discusses a report in 2009 by the World Health Organization that stated in America 75% of people did not consume enough magnesium in their diet. This may be due to the prevalence of fast or processed food intake. Interestingly consumption of alcohol even in moderate amounts can double or even quadruple the loss of magnesium from the body.

Deficiency in magnesium has been blamed for many illnesses including irregular heart beat, high blood pressure, anxiety, seizures, leg cramps, restless leg syndrome, fatigue, weakness, pre menstrual syndrome, osteoporosis and fibromyalgia. He points out that blood tests are not a reliable indicator of a person’s magnesium level but in people presenting with the issues described above, low magnesium should be considered

The recommended daily intake of magnesium varies according to whether you are male or female but Lundberg says 400mg is an average amount to include in your daily intake, preferably from your diet.

Magnesium is found in dark leafy greens, especially kale and spinach and broccoli, tree-nuts and peanuts; seeds; oily fish; lentils, legumes, whole-grains, avocado, yoghurt bananas, kiwi fruit, dried fruit, dark chocolate and molasses.

Check with your doctor whether or not it is ok to take a supplement if don’t think you are getting enough magnesium in your diet.  (I think I know what my supplement might be……!)

A Drink a Day May Boost Risk for Certain Cancers

Another study showing an increased risk for cancer with drinking alcohol, even with just one or two drinks a day, has prompted renewed warnings on the health risks associated with alcohol consumption.

The new study, from an analysis of more than 150,000 healthcare professionals in the United States, found that overall, light to moderate drinking (alcohol intake of <15 g/day for women and <30 g/day for men) was associated with a small but non-significant increase in cancer risk in both women and men.

But this risk was more defined in specific populations. In men, the association was apparently driven by tobacco use. But for women, even one drink a day was associated with an increased risk for alcohol-related cancers, primarily breast cancer, and this was unrelated to smoking status.

The study was published online August 18, 2015 in the BMJ.

Some interesting nutrition news –  thank you Sarah, our dietician, for these links.

Healthy eating

Colour recipe wheel

The Queensland Health colour wheel – making fruit and veges look very attractive!

This is a great resource as has lots of evidence based nutritional information, including an app and healthy recipes.

Go to healthier.qld.gov.au/tools/colour-recipe-wheel/

Sugar Myths

It is often difficult to sort fact from fiction in relating to diets. You may well have heard that sugar should be avoided in the diet because it feeds cancer, this article looks at myths and facts relating to this topic and well worth reading.

Sugar and cancer myths by Queensland Health – Nemo resource available at:

https://www.health.gov.au/nutrition/resources/oncol_dietmyth.pdf