Physical Activity and Diabetes Management among Community Members in M'bour, Senegal

Introduction Methods

Objectives

Results

Sample, Recruitment, and Measures

Rhoda Moise, B.S.1, Rhonda BeLue, PhD2

1PhD Class of 2019, University of Miami Department of Public Health Sciences, 2Health Policy and Administration, The Pennsylvania State University, University Park, PA

References

Results

• Diabetes mellitus concern in developing countries, including Sub-Saharan Africa• Africa projections:

• Increase in from 19.8 million in 2013 to 41.4 million in 2035 (1)• Non-transmissible diseases (aging, sedentary lifestyle, obesity)

• Senegal status:• 17.9% urban population living in Dakar fasting blood glucose levels ≥

1.10 g/L and/or being treated for diabetes in 2009 (2)• Cultural and economic factors:

• Medication adherence challenges availability and cost (1, 3, 4)• Lifestyle modifications to diet and physical activity important

• Limited information related to effect of culture on adherence to physical activity guidelines for diabetic patients in this population

Using qualitative and quantitative methods, this study examines physical activity habits and potential cultural enablers and barriers to physical activity in individuals with type 2 diabetes in M’Bour, Senegal.

• Semi-structured interviews guided/analyzed by PEN-3 Model (content analysis)

• International Physical Activity Questionnaire (SPSS)• Wolof to English verbal translation

• Sample: M’bour, coastal city 80 kilometers south of the Dakar (pop ~ 195,000)• Participants: 41 individuals mean age 58 (SD=11.8) from DM

association, local hospital, community members • Recruitment: verbal from executive committee and local research associate

• Compensation: 2500 West African CFA Francs, the equivalent of 5 USD

• Measures: demographics (age, occupation, marital status)• IPAQ, exercise regimen, attitude towards exercise, and barriers

• Additional questions:• Do you think sports are important? Do you currently participate in

sports? What kind of exercise do you do? Do you have any pain when you exercise? What are your barriers to exercising? Do you have anyone to exercise with? Did you have to stop exercising due to your health? What kind of support do you need to help you exercise?

1. J. C. Mbanya, F. K. Assah, J. Saji, and E. N. Atanga. Obesity and type 2 diabetes in Sub-Saharan Africa. Curr Diab Rep, 14:7, pp. 501, 2014.2. P. Duboz, N. Chapuis-Lucciani, G. Boetsch, and L. Gueye. Prevalence of diabetes and associated risk factors in a Senegalese urban (Dakar) population. Diabetes and Metabolism, 38:4, pp. 332-336, 2012.3. 7. L. Baumann, C. K. Opio, M. Otim, L. Olson, and S. Ellison. Self-care Beliefs and Behaviors in Ugandan Adults With Type 2 Diabetes. The Diabetes Educator, 36:2, pp. 293-300, 2010.4. K. Hjelm and E. Mufunda. Zimbabwean diabetics’ beliefs about health and illness: an interview study. BMC International Health and Human Rights, 10:7, 2010.

Positive Negative Existential

Perceptions Acknowledge importance of treating diabetes;

universal awareness of therapeutic value of

proper diet

Lesser regard for exercise compared to diet and medication

in terms of controlling diabetes

Disease burden of non-communicable

disease is high in SSA

EnablersPresence of gym in the

community; local beach a site of high level of physical activity

Prohibitive cost of gym membership and exercise equipment

Open spaces for walking;

walking common mode of

transportation

Nurturers Family support in maintaining healthy

behaviors

Lack of exercise partners

Local culture values dance, sports such as futbol and wrestling,

and movement

Theoretical Model

Figures 2 and 3. Patient with amputated toe and diabetic card instructions for emergency notification

Figure 1. Google Maps image of M’bour Senegal location

• Qualitative:• Semi-structured interviews:

• I stopped taking my medication for two months because it was too expensive and I could not afford it. (58-year-old female) Amy Diouf

• They tried to get me to stop eating rice, and I said that will never happen. (66-year-old male) Djibril Ndiaye

• I exercise by going to the market, cooking, and cleaning. (48-year-old female) Fatou Mata Ndaiye

• Barriers:• Costs of gym membership, exercise equipment, limb pain,

feeling ill, and lack of exercise partners• Enablers:

• Familial support aided in maintaining exercise behaviors • Quantitative:

• IPAQ• Exercise average 4 days per week (SD=2.8)

• Walking- 61 minutes (SD=85)• Moderate/vigorous exercise was reported by less than 22%

• Mod- 26 minutes (SD=62) 1 day (SD=2), 4 people vigorous

• Sitting average 7.43 hours (SD=4.6)

Table 1: Cross reference of perceptions, enablers, and nurturers as positive, negative, and existential values involving proper diabetes management.

Rhoda K. MoisePhD Student

Prevention Science University of Miami 2019rkm54@med.miami.edu Phone: (267) 357-0388

Acknowledgements and ContactThank you to Dr. Rhonda BeLue for her

mentorship. Thank you to The Pennsylvania State University’s ARC, SHC, MRC, and College of HHD for funding this research. Thank you to

the University of Miami and the McKnight Doctoral Fellowship for their travel support.

PersonExtended FamilyNeighborhood

PerceptionsEnablersNurturers

Positive ExistentialNegative

THE PEN-3 CULTURAL MODELCULTURAL IDENTITY

CULTURAL EMPOWERMENT

RELATIONSHIPS & EXPECTATIONS

Conclusion• Educational orientation

• Obesity and exercise/physical activity in managing diabetes• Food security and financial stability

• Access to healthy diet and physical activity with income obstacles• Physical Activity:

• Predominantly sedentary behaviors, not meeting PA recommendation• Culture and health:

• Health care professionals must provide sensitive and appropriate recommendations

• Patients may benefit from learning home-based exercises that are gentle and may alleviate pain or group-based exercise activities

• Interventions must consider West African values of family functioning