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The Role of Religion, Spirituality and Fasting in Coping with Diabetes among Indian Migrants in Australia: A Qualitative Exploratory Study

Abstract

Australia has a high proportion of migrants, with an increasing migration rate from India. While many factors influence diabetes self-management among Indian migrants, very little is known about the influence of religious beliefs and spirituality. This study explored the religious beliefs of Indian migrants in Australia and the influence of those beliefs on their diabetes self-management. Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Most participants believed that prayers helped them alleviate stress and improve diabetes management participants also believed that receiving blessings/prayers from religious leaders prevent or cure diseases including diabetes. There were mixed views on beliefs about using insulin obtained from animal sources. Some participants were concerned about the use of animal-based insulin as it was against their religious beliefs and teachings. Some participants believed that religious fasting does not have any impact on their diabetes while others believed that it can be detrimental to their health. Religious beliefs therefore played an important role in how Indian migrants managed their diabetes. Healthcare professionals should consider their patients’ religious beliefs during consultations, enlist support, such as religious scholars, to better address people’s misconceptions, and identify strategies for effective diabetes management that consider religious beliefs.

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Acknowledgements

Sincere gratitude to all study participants for taking part in the study; and Indian associations/organisations/newspapers for their assistance in advertising this project.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

AA and PA designed the research study. AA collected and analysed all the data, and wrote the first draft of the manuscript. PA contributed to data analysis. MU and PA contributed significantly to all drafts of the manuscript and its final version. All authors have read and agreed with the final manuscript.

Corresponding author

Correspondence to Akram Ahmad.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Human Research Ethics Committee (2018/415) of The University of Sydney. The patients/participants provided their written informed consent to participate in this study.

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Appendices

Appendix 1 Qualitative Study Interview Protocol

Interview Protocol and Data Sheet-Patient Interviews

Patients will be informed verbally by the researcher about the study; will then be given the Participant Information Statement to read, and asked to read and sign the consent form, if agreeing to participate in the study. Participants will be encouraged to ask the interviewer if there is anything unclear, or if they need more information.

The process will then begin as follows:

Before we formally begin the interview, I would quickly like to ask you a few questions:

figure a

Interview questions:

Question 1: What do you know about accessing the Australian healthcare system?

Prompts;

  • If you were sick or your family member, how would you go about getting help?

  • From where can you get OTC medicines?

  • If you had a minor illness, what would you do?

  • If you had a more major issue, what would you do?

  • If you have an emergency, where do you need to go?

Question 2: When do you seek help for your diabetes illness?

Prompts;

  • Please share your experience about when you went to see your doctor?

  • Regularly visit/irregular visit, why?

  • When my diabetes uncontrolled?

Question 3: How were you diagnosed with diabetes and how do you feel being diabetic?

Prompts:

  • Went to see doctor for other disease? Suspect symptoms of diabetes?

  • How did you feel when the doctor first told you that you had diabetes?

  • How has your feeling changed over time?

  • How has diabetes and the medication(s) you take for diabetes affected your day to day living?

  • How has diabetes and the medication(s) you take for diabetes affected your lifestyle in general?

Question 4: Where and from whom, do you get information about your diabetes and medications you take for diabetes?

Prompts;

  • In your day to day life where you get information about diabetes and its medications? (healthcare professional in hospital, community pharmacy, internet, media or other)

  • Do you think that information in Hindi is more useful to you compared to in English

Anything you would like to suggest to improve health information

Question 5: What are some of your difficulties and facilitators (motivators) for you for seeking diabetic care in Australia?

Prompts;

  • What are problems you face while needing help regarding diabetes and its medications?

  • In your personal experience, what are the factors affecting you visiting a clinic in Australia?

  • What are the enablers while seeking healthcare in Australia?

  • Was there anything that you liked or didn’t like?

Question 6: What are your thoughts about the level and amount of information that healthcare professionals provide/give to you about your diabetes?

Prompts;

  • Do you feel that it is easy or difficult to understand?

  • Do you feel that you need more or less information?

Question 7: What are your thoughts about your knowledge about diabetes and its medications?

Prompts;

  • Inadequate knowledge

  • Do you think you need more information

  • Is there anything in particular that you are interested in knowing about (diabetes or medications or both)

  • Do you think that you manage your diabetes well?

Question 8: What have your experiences with diabetes management been while you have been living in Australia?

Prompts;

  • In your experience what are the major differences in India and in Australia

  • How do you seek help?

Question 9: What does health or well-being mean to you? What do you do to keep yourself as healthy as possible, considering that you have diabetes?

Prompts;

  • Please tell me what you do in terms of food intake, types of food you eat; in terms of exercise to keep blood sugar normal

  • Easy or hard to manage as compared to India, why?

Question 10: How do you manage to take medications as per prescribed by your physician?

Prompts;

  • Based on your experience, please suggest strategies that you think might help to improve medications adherence?

Question 11: Do you or have you used any Indian traditional medicines to control your blood sugar? Why? How have they worked?

Prompts;

  • In Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), which system you follow and why?

  • In your opinion what are the reasons that you and your family consider to use this medicine. (more effective, safe, less expensive and side effects, better to control blood sugar or permanent cure)

  • How often do you take them?

  • How you know about these medicines and from where do you get them?

  • Have you / do you inform your doctor about these medicines? Reason?

Question 12: What are your thoughts about spiritual health? How do you believe it impacts or influences your diabetes or what you do about your diabetes?

Prompts;

  • What is your personal experience or views about meeting a spiritual healer like a priest (Hindu), imam (islam), father (Christian), darbar sahib (sikhs), etc., or traditional healers or religious leaders to seek prayers

  • What is the reason for getting this help?

Question 13: What are your religious beliefs about insulin and other medications? How do these beliefs impact your diabetes management?

Prompts;

  • Bovine insulin (cow)

  • Porcine insulin (pork)

  • Haram and halal

  • Neutral (no effect)

Question 14: How do you manage your blood sugar during religious fasts?

Prompts;

  • Based on your personal experience, please suggest strategies that you used to manage diabetes during fasting? (It’s difficult or easy, diet control, managing side effects, Fasting is good to control diabetes?, feel weak?).

Appendix 2 COREQ (Consolidated Criteria for Reporting Qualitative Research) Checklist

Item no Topic Guide questions/description
  Domain 1: Research team and reflexivity
  Personal characteristics
1 Interviewer/ facilitator Akram Ahmad
2 Credentials BPharm, PharmD (Post Baccalaureate)
3 Occupation PhD Candidate and Registered Pharmacist
4 Gender Male
5 Experience and training A registered pharmacist from India; with experience in teaching and research. Trained in qualitative techniques
  Relationship with participants
6 Relationship established Before each interview began, the researcher established relationship with the participant to the best of his ability
7 Participant knowledge of the interviewer Before starting an interview, each participant received a participant information statement (PIS) in their preferred language (English or Hindi) approved by the University of Sydney 's Human Research Ethics Committee, Australia
The name and address of the researchers and their affiliation (Sydney University) was also included as part of the letter head appearing on the PIS document. Participants have knowledge about that. The researcher (name, affiliation, and role in the research) also introduced himself before each interview started
8 Interviewer characteristics PhD Candidate, academic researcher, and pharmacist. The researcher has remained to the best of our knowledge, Unbiased during the interviews
  Domain 2: Study design
  Theoretical framework
9 Methodological orientation and Theory No methodological orientation underpinned the study design. Thematic analysis was used to analyse the findings
  Participant selection
10 Sampling The convenience and snowball sampling used to locate the participants in Australia. The participants were recruited based on criteria set for the study for inclusion and exclusion
11 Method of approach Usage of different techniques to find the participants
The methods have been described in qualitative methods section
12 Sample size 23 participants completed the study
13 Non-participation 19 [initially 42 participants shows their interest to participate in the study, later some of them not available due to various reasons and later we reached saturation and no contact has been made further]
  Setting
14 Setting of data collection Public venue suitable for the participant
15 Presence of nonparticipants In 18 interviews, only the participant and researcher were present. 2 participants were accompanied by spouse and 1 participant were accompanied her mother-in-law
16 Description of sample Indian born migrants living in Australia [ethnicity]. The detailed description given in qualitative methods
  Data Collection  
17 Interview guide The interview guide is shown in Appendix 1
18 Repeat interviews Repeated interviews were not performed and do not apply to this study
19 Audio/visual recording Audio recording was used to collect the data
20 Field notes Field notes were made right after each interview
21 Duration The mean average duration of the interviews was 42.45 min
22 Data saturation Data saturation was reached
23 Transcripts returned Transcripts have been transcribed verbatim and checked against audio to ensure accuracy prior to analysis. Transcripts were not returned for statement or correction to the participants
  Domain 3: analysis and findings
  Data analysis
24 Number of data coders AA and PA were analysed data using a framework for TA. The first four interview recordings were transcribed by AA and reviewed by PA. These four transcripts independently analysed by AA and PA; and the remaining analysed by (AA). The interviews recordings were fully transcribed and thematically analysed
25 Description of the coding tree The coding tree (diagram) is presented in qualitative method chapter (Fig. 6.2)
26 Derivation of themes Wide themes were used to build interview guide to answer research objectives. Specific themes developed from interviews, one of which appears here
27 Software Microsoft Word was used to manage the data
28 Participant checking Participants did not provide feedback on the findings
  Reporting
29 Quotations presented Representative quotations were presented while the findings were reported
30 Data and findings consistent There is consistency in the data and findings presented
31 Clarity of major themes Major themes are presented in Fig. 6.2 (qualitative method)
32 Clarity of minor themes Major themes are presented in Fig. 6.2 (qualitative method)

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Ahmad, A., Khan, M.U. & Aslani, P. The Role of Religion, Spirituality and Fasting in Coping with Diabetes among Indian Migrants in Australia: A Qualitative Exploratory Study. J Relig Health 61, 1994–2017 (2022). https://doi.org/10.1007/s10943-021-01438-9

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Keywords

  • Indian migrants
  • Type 2 diabetes
  • Religion and spirituality
  • Fasting in diabetes
  • Insulin