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Perceptions of Diabetes, Hypertension, Healthy Eating, and Physical Activity within the Bhutanese Refugee Community Living In Metro Atlanta

Contino, Robert (2012)
Master's Thesis (97 pages)
Committee Chair / Thesis Adviser: Hennink, Monique
Committee Members: Saenger, Michael S
Research Fields: Health Sciences, Public Health
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: Diabetes; Hypertension; Beliefs; Bhutan; Healthy eating; Physical activity; Refugees
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url:


Background: In 2006 the U.S. government agreed to the resettlement of 60 of the 107 thousand Bhutanese refugees living in UN refugee camps in Nepal. As of 2011, over five thousand have resettled in Metro Atlanta. A recent retrospective chart review of Bhutanese patients from an Atlanta-based primary care clinic demonstrated a high prevalence of chronic diseases. This finding, paired with the expressed concerns from a group of Bhutanese community leaders living in Atlanta about this issue provides the motivation for a community-based chronic disease prevention initiative. However, to be effective, health promotion activities and messages must be culturally tailored, done with an understanding of the meaning attached to certain behaviors and conditions, and congruent with community norms, understanding, and values.

Purpose: The purpose of this study was to explore the beliefs and perceptions of diabetes, hypertension, healthy eating, and physical activity among the Bhutanese refugee community living in Metro Atlanta with the plan to use this information to design future chronic disease prevention initiatives.

Methods: We performed a qualitative study using focus groups and key informant interviews.

Results: We found that younger individuals had a basic understanding of diabetes and hypertension, while older refugees expressed knowing little about these diseases. All participants emphasized the acute symptoms associated with each illness, however had poor understanding of the insidious nature of diabetes and hypertension. Bitter foods (e.g. bitter gourd) was a commonly cited treatment for both diabetes and hypertension. Beliefs about what constitutes healthy eating and physical activity were generally consistent with the biomedical understanding. Numerous barriers to healthy eating and physical activity, however, were described, including: time, family tradition, social motivation, and neighborhood safety.

Public Health Implications: Future public health initiatives within this community should take into consideration the unique refugee experience of the Bhutanese people, their collectivistic values, their use of herbal preparations, belief about importance of traditional eating habits, and unfamiliarity with the paradigm of chronic disease.

Table of Contents

1. Chapter 1: Introduction...1
2. Chapter 2: Literature Review...9
3. Chapter 3: Methods...24
4. Chapter 4: Results...34
5. Chapter 5: Discussion...62
6. Chapter 6: Public Health Implications...75
7. References...80
8. Tables...85
9. Appendix...86


application/pdf Dissertation/Thesis 97 pages (442.5 KB) [Access copy of Dissertation/Thesis]
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