Diabetes Self-Management
Peer Outreach Toolkit for
the Bengali Community
Table of Contents
Table of Contents INTRODUCTION
Acknowledgements
1
Background
2
Peer outreach 4
Bengali Community 6
TOOLKITS
How to build a trusting relationship
8
How to reach the Bengali community
10
Organizing a meeting/workshop
12
Barriers faced by the Bengali community
14
Health beliefs and practices
16
Challenges in managing a healthy life
19
Peer Outreach Training Program 20
MODULESHow to reach the Bengali community and recruit peer
21
outreach workers
Peer support models
23
Meetings/workshops
24
Communication barriers
26
Model for Collaborative Learning
28
Settlement barriers
30
Geert Hofstede™ Cultural Dimensions
32
Settlement.org
35
Self-management of diabetes and other chronic diseases
37
Stress management
39
Barriers to self-management
41
Types of barriers
Strategies for addressing barriers to 45
self-management of diabetes and other chronic diseases
RESOURCES
Strategies for addressing barriers Acknowledgements
43
47
We gratefully
Funder
DEC NET Staff
acknowledge our funder
Public Health Agency
Hilary Hall
and the individuals
of Canada
Melanie Stanton
and agencies who
(to follow)
generously gave
their time, talent and
Radha Ramsammy
Peer Outreach Leaders
expertise in support of
Afroza Sultana
this tool kit.
Bilkis Rina
Dalia Lucky
Dolly Malek Khondakar
Mythri Vijendran
Denise Galbraith
Lori Sutton
South Riverdale
Hasina Begum
Community Health Centre
Hasina Talukder
Susan Bender
Hafsa Siddika Imam
Gurpreet Karir
Humaira Ummehani
Grace Ho
Irin Hossain
Jinnat Ara Basher
Kauser Firdous
Nazma Akter Khanam
Najmin Sultana
Black Creek Community
Health Centre
Michelle Westin
Parveen Taher
Taslim Ara Ratna
Md. Rabiul Islam
Shahanaj Begum
Editor
Peter Sellers
Shuvra Rani Sen
Peer Outreach Coordinator
Khaleda Yesmin
Project Coordinators
Stephanie MacLaren
Maria Lee
Kelly Grover
1
Background
South Riverdale Community Health Centre (SRCHC) is a communitybased organization that offers primary health care services and
health promotion programs to community members within a diverse
community. SRCHC is the lead agency of the Diabetes Education
Community Network of East Toronto (DECNET). Funded since 2002
by the Ontario Ministry of Health and Long Term Care, DECNET is a
partnership between South Riverdale Community Health Centre, East
Based on these recommendations, in 2009, DECNET began to
The purpose of this
develop a peer outreach strategy for the Bengali community. In 2010,
Tool Kit is to provide
DECNET secured funding from the Public Health Agency of Canada
information and
to enable a sharing of our learnings and to develop a peer outreach
tools to support the
tool kit for others to use. The purpose of this tool kit is to facilitate the
development of a peer
development of a peer outreach program in the Bengali community
outreach program in
focused on diabetes self management.
the Bengali community,
focused on diabetes self-
Methodology
End Community Health Centre and Toronto East General Hospital.
management.
The mission of the program is to provide relevant diabetes self
In this tool kit, you
management support and services to adults with type 2 diabetes living
will find:
in East Toronto. Particular emphasis is placed on increasing access for
• An overview of the
A number of sessions were held with these representatives to better
typically under-serviced groups, such as new immigrants.
Bengali community
understand their health beliefs and practices, including their self-
• Strategies to
management practices, as well as the barriers to managing their
In 2008, DECNET began a comprehensive community needs
recruit peer outreach
health. This content was synthesized and helped to inform the draft
assessment as a means of evaluating the program’s work with the
workers from within this
tool kit. The draft tool kit was then reviewed by DEC NET and South
South Asian communities. While DECNET’s client base included
community
Riverdale staff who provide service to the South Asian community and
members from these communities, the number of clients attending
• An overview of
supportive programs or evidencing improvement in their self-
the health beliefs and
management behaviours was quite low. In 2009, a community meeting
practices of the Bengali
was held to discuss the issues of self management in this population.
community, with specifics
An additional twenty two 22 Bengali community members
The recommendations from this meeting were: 1) do not treat South
on diabetes beliefs and
were subsequently recruited and with the original eighteen 18
Asians as a homogeneous group; 2) take a multifaceted approach to
practices
representatives, DECNET used the tool kit to train these members
• An eight week peer
to function as peer outreach workers in the Bengali community. This
outreach curriculum
training took six weeks and the input and feedback of the participants
(eight modules) to train
helped to refine the modules.
providing diabetes self-management supports and services; 3) foster
positive health seeking behaviours and increase health literacy among
newcomer populations. It was stated throughout the consultation
process that for this community, it was not common practice to see a
physician except in acute health care settings. It was also noted that
many groups face a stigma around diabetes creating further hesitancy
to seek out supportive programs. As such, the final recommendation
of the consultation process was to foster peer outreach/education
strategies aimed at addressing health beliefs and referring people to
appropriate resources.
2
About this Tool Kit
The tool kit was developed by through a thorough consultation
process. To begin, DECNET recruited eighteen representatives from
the Bengali community who had diabetes or who were pre-diabetic.
community agency partners who provided further feedback resulting in
some slight changes.
peer outreach workers on
how to function as a peer
outreach worker for the
promotion of diabetes
self management
Each of these peer outreach workers then conducted a few outreach
sessions in their community to test their knowledge and skills. Their
effort was assessed by an external evaluator who recommended that
two additional sessions be added to the peer outreach curriculum.
Accordingly, the final program is scheduled for eight 8 weeks.
3
Peer Outreach
The efficacy of peer
“Outreach is an effort by individuals in an organization or group
supported education
to connect its ideas or practices to the efforts of other organizations,
and outreach is well
groups, specific audiences or the general public”. Outreach often
documented in the
takes on an educational component (i.e. dissemination of ideas),
literature and according
but it is increasingly common for organizations to conceive of their
to the Canadian
outreach strategy as a two-way street in which outreach is framed
Diabetes Association
as engagement rather than solely as dissemination or education.
is oft cited as a best
(Retrieved from en.wikipedia.org/wiki/Outreach)
practice. There
are many different
definitions of peer
outreach. A key
commonality in the
definitions is the bridge
that the worker plays
“Peer support occurs when people provide knowledge, experience,
emotional, social or practical help to each other. [Peer support]
Experience/Skills:
commonly refers to an initiative consisting of trained supporters, and
• A good understanding of the settlement process and newcomer
can take a number of forms such as peer mentoring, listening, or
counseling.” Retrieved from en.wikipedia.org/wiki/Peer_support)
linking the community to
the needed information
Roles and responsibilities of a Peer Outreach Worker
or supports. Listed are
The primary role of a peer outreach worker is to provideknowledge,
some definitions and the
definition used for the
purpose of this project.
experience, support to their community. They can play a critical
issues in the community
• Proficiency in organizing meetings and workshops
• Networking experience and or skills
• Excellent communication and interpersonal skills
• Knowledge and awareness about community resources
coordination role between the community and service providers. Listed
• Knowledge about group facilitation
are some suggested key duties and experience and skills of a Bengali
• Work experience in a community-based setting
peer outreach worker.
• Flexibility
Main duties and responsibilities:
• Outreach to community people including isolated members
• Provide one-to-one support
• Inform families about appropriate resources and service
providers contacts
• Coordinate meeting logistics and communicate to participants
about meeting time, etc.
• Faciliate meetings
• Communicate with agencies to ensure language specific services
• Liaison with the service providers
4
5
Bengali Community
• Guests are generally served first then the oldest person, continuing
in order of seniority or age.
• According to Statistics Canada census in 2006, 25,000 Bangladeshi
live all over Canada. Among them, most live in Ontario (16,000)
followed by Quebec.
• In 2010, the Migration and Diabetes research project showed
that 35% of this population has diabetes. The study also
showed that post migration stress, major social, economic and
linguistic barriers to care are the key hindrances for taking care
of their health.
• The Bengali community lives in the Bengal region and more than
98% of the Bengali population speaks Bangla (known as Bengali).
The Bengal region is divided between Bangladesh and India and
is located in South Asia. This region is located on the North Bay of
Bengal and it is surrounded by rivers.
• Most of the people are of either Muslim (89.5%) or Hindu (9.6%)
faith and 0.9% are from other ethnic groups. Generally Bengali
marriage is arranged, however Hindu and Muslim marital
• A meal is considered incomplete without a carbohydrate
(e.g. bread, rice).
• People eat with their hands not utensils. They always wash their
hands before eating.
• Shaking hands as a greeting is common between men but
not women.
• Using the left hand to receive things or to accept things is
considered disrespectful and shows poor manner.
• Women are permited to work outside the home if their
husband deems it appropriate.
• Bengalis stand close when speaking to someone of the same
gender and touch is common. However when speaking to a woman
then personal space should be increased.
• Using body language is common when speaking and people
often speak loudly as a normal part of their conversation.
practices differ.
• The most common greeting is “Assalam Alaikum” (for Muslims) or
“Namaskar” (for Hindu) – both mean “peace be unto you”.
Source :
http://www.kwintessential.co.uk/resources/global-etiquette/bangladesh.html
• As of July 2011, the estimated population will be approximately
160 million
• The Bengali culture is patriarchal and men are the decision makers
for their family. People are respected according to their age and
social position.
• The largest religious festivals are Eid-Ul-Fitr and Eid-Ul-Adha
for Muslims and Durga Puja and Kali Puja (worship to Goddess)
for Hindus and Christmas for Christians.
• Education is extremely valued within this community and people
are respected according to their education.
• Entertaining family and friends is very important and Bengali
people enjoy inviting people to their homes for food and
refreshments. It is not polite to have someone to your home
without offering them something to eat or drink.
6
7
How to Build a
Trusting Relationship
Building trust is
• Spend time within the community and get to know people
important for community
• Leverage your relationships with other Bengali community members
engagement. Trust
makes relationships
easier, friendlier and
as they will help others in the community to trust you
• Participate actively in social, cultural and religious events such as:
1. Bangla New Year Festival
Building trust with the
2. International Mother Language Day
Bengali community
3. Independence Day
4. Victory Day
of your intentions. Below
5. Buddha Purnima Festival
are some useful tips to
6. Eid-Ul-Fitr and Eid-Ul-Azha Festival
help build a trusting
7. Durga puja Festival
8. Christmas
more comfortable.
can take some time as
people may be suspect
relationship.
• Try to dress as they dress for one or two festivals
• Participate in Food Festival (such as the Home-made Cake Festival)
• The community is very conservative when it comes to disclosing any
personal information, especially health information. You will need to
stress that all information will be kept confidential.
8
9
How to Reach the Bengali
Community and Recruit
Peer Outreach Workers
• Religious festivals such as:
— Eid-Ul-Fitr
— Eid-Ul-Azha
— Durgapuja
— Buddho Purnima
From community
• Find someone from this community who you know
— Christmas
research, we know the
• Talk with that person about your outreach plan
— Easter
• Get his/her feedback on strategies for reaching the community
— International Mother Language Day – 21 February
• If you do not know anyone in the community, contact community
— Independence Day – March 26
— Victory Day – December 16
— Bengali New Year – April 14 (Varies with moon)
following steps are
likely to be effective in
reaching the Bengali
community. We also
agencies that operate in the neighbourhood to help you to identify
know that having
a community leader
someone from the
community conduct
the recruitment is
very important in the
successful recruitment
of Bengali community
• Attend one of the chosen agency’s events or social gatherings to
introduce your project
• Develop flyers in Bengali and distribute in areas where the
community can be found such as:
• Conduct door to door visits
• Once you find some interested people, ask them to recruit members for you.
• Neighbourhood apartments (laundry room) members for a peer
• Resource centres
outreach program.
• Local libraries
• Community centres and cultural organizations
• Health centres/hospitals
• Day care
• LINC/ESL
• Neighbourhood shopping centres and stores
• Bengali media
• In front of subway stations/bus stops
• Mosques, temples
• Internet networks
• Cultural events
10
11
Organizing a MEETING/
WORKSHOP with the
Bengali Community
Listed is some guidance
Choosing a meeting location
on how to organize and
• Find a meeting location within their neighborhood that is walking
run a meeting with the
Bengali community.
distance for most people and accessible to those who are physically
challenged
How to set meeting date and time
• Ask participants to identify times that they are available to meet
• Adjust your time to match that of the majority
• Confirm with participants that they are committed to attending
• Ensure you contact participants a few days prior to the meeting to
remind them of the meeting location and time
Refreshment
• Serve snacks that are familiar to the participants
• Ensure there is childcare as many people will bring their children
• Ensure all food is Halal
• Consider the need for space to pray should the time for praying
• Don’t serve any raw vegetables and only fruit that can be peeled;
coincide with the meeting time
• Ask for input on the location to ensure it is acceptable to the
ensuring food can be washed properly is of significant importance
to this community
community
Running the meeting
• Many people will not come to the meeting on time and may have
to leave early
• People may be reluctant to discuss health issues
• Start meeting with a check-in with the participants (e.g. ask how
people’s week was)
• People may come late and go early 12
13
Barriers Faced by the
Bengali Community
Bengali immigrants
Language
arrive in Canada with
• Difficulties in understanding the local language
high hopes. Based on
the screening process
of their immigration
• Difficulties in being understood
• Complex wording on official documents applications (for
education, language,
skills, experience),
they arrive with the
belief that successful
settlement will come
Child care
• Young children at home
• Concerns about the security of child care due to unknown
baby sitter
quickly. This is not
• Expensive child care system
always the case. The
• Long waiting times to get child care
shock of the realities of
settling into Canadian
• Adjusting to child care practices of a new culture
culture can create
difficulties and cause
Language
considerable stress.
• Difficulties in understanding the local language
During workshops,
participants identified
many barriers
• Ability to rent a house depends on the level of income
• Long wait for subsidized housing Climate
• A huge barrier
• Not used to cold winter weather, snow etc.
Information
• Don’t know how to navigate system
• Often get information through word of mouth which can be
incorrect information
• Lack of internet experience Health system
• Don’t have a primary care provider and not sure how to access one
• Lacking continuity of care because accessing different providers
at different times (e.g. walk in clinics)
• Frustration caused by long waits for diagnosis in the case of
chronic illness
• Difficulties in being understood
• Complex wording on official documents and challenges to
successful settlement
and their ability to
manage their health.
Employment
• Difficulty finding work/jobs related to experience
• Different job system and working conditions (such as standing
at work rather than sitting)
• Need for references to find a job • Lack of Canadian experience Housing
• High housing rent (compared to income)
• Lack of suitable houses/apartment
• Renting a house is not possible without a guarantor
14
15
Common Health Beliefs
and Practices of Bengali
Community
A comprehensive
needs assessment was
conducted in 2008
among various ethnic
groups including the
Bengali community.
Based on that study,
a community research
project was completed
in 2010 focusing
on common health
beliefs and practices
within the Bengali
Health Beliefs:
• Doctor’s advice is important and needs to be sought when they or
a member of their family feels sick
– Check blood sugar regularly
– Pray to God for a cure
– If blood pressure rises, lie down for awhile and if necessary
take medicine
– Make phone calls to friends and family back home for support
– Get involved with community supports and agencies
Common Beliefs and Practices Regarding Health:
Belief
• Bengali members belive it is important to:
– Have regular check ups
Practice
Regular health check up
X
Regular exercise
X
X (not all)
– Eat regularly and at appropriate times
Regular meals
X
X
– Check blood pressure regularly
Taking medicine as per doctor’s advice
X
X
– Include fresh food in every meal
– Exercise regularly
– Worship regularly
– Stay happy, cheerful and positive
• Good health can be achieved by:
Women do not make their health a priority
Prefer natural medicine to
– Spending time with friends and family
common health beliefs
– Getting enough natural vitamins
Tend to ignore minor health problems
and practices as well as
– Eating bitter foods as they are believed to prevent disease
Seek medical help from a doctor
their perceptions and
– Keeping weight gain to a minimum as weight is thought to
when illness is out of control
management of their
contribute to many disease
diabetes follows
– Changing food habits as this will prevent diabetes
80-90% of the community manage their health based on traditional
family health practices
• Diet:
– Eat regularly but not always at appropriate times. For instance,
many have late dinners due to competing responsibilities.
– Sometimes follow balanced diet but not always
• Exercise:
– Try to exercise (walking) but some not able to do so regularly
• Avoidance of medicine:
– Try to stay healthy without taking pharmaceuticals
X
X
X
pharmaceuticals
community. A list of
Health Practices:
16
• Other:
Get medical advice from friends
X
X
X
X
and family
Concerns about Diabetes
Social status
• Worry that diagnosis of diabetes will result in loss of social status
and will impact opportunity for children to be married (particularly
for female children)
• Worry that living with diabetes will result in a sense of isolation from
others
• As a result, don’t want to answer questions about their diabetes,
don’t want to turn down sweets at social functions and don’t want to
test for blood sugar because don’t want to disclose their diabetes
17
Challenges in Managing
a Healthy Life
Fear of the future
• Fear of a decline in physical strength and the ability to work
Patriarchical Culture
• For some women, it is up to the husband how her diabetes is
managed. Women are concerned that husband may not
Migration to a new
understand diabetes.
country where culture,
• Women prefer to have a female doctor which may delay
their treatment.
language, climate and
food are totally different
is a huge challenge.
These settlement
barriers can impact their
ability to manage their
Challenges to managing a healthy life:
• Knowledge:
needed to maintain good health
– Lack of general education about health issues
• Lifestyle change:
– Lifestyle changed significantly which has contributed to
disruption of eating, exercise and increase mental stress
diabetes and lead a
healthy life
– Lack of knowledge about symptoms of diabetes and what is
• Exercise:
– Insufficient walking or exercise due to lack of time and
competing priorities (family and social responsibilities, job
pressures, etc.)
– Not comfortable exercising in front of other people (culture)
• Diet:
– Diet control is challenging. Don’t know where to access foods
they are familiar with and strong desire to eat carbohydrates.
– Find it difficult to control blood sugar levels.
• Weather (especially the Canadian winter)
– Lack of experience with winters causes stress and impacts ability
to get out for food, exercise and appointments
Priority health challenges:
• Mental stress
• Diet control due to migration,
settlement and lack of education
about healthy diets
• Change in eating habits and the
effect of unfamiliar foods
• Exercise due to their cultural
environment in which women do
not go the gym and do not have
structured exercise classes or fitness clubs
18
19
How to Reach the Bengali
Community and Recruit
Peer Outreach Workers
Peer Outreach
Training Program
To assist you in training your Bengali peer outreach workers, an eight
week training program follows. The training is designed to help you
to increase the awareness of the peer outreach workers to their own
health issues and therefore provide them with the knowledge and skills
to effectively facilitate sessions to promote diabetes self management
Module
Objective of the session:
• Participants learn about peer outreach and share their
outreach experiences
or other chronic disease self management in their community.
Output of the session:
Module topics include:
• How to outreach the Bengali community and build a trusting
relationship
How to reach Bengali community and recruit
peer outreach workers
Organizing Meeting/Workshop with the
Bengali community
Barriers faced by the Bengali community
Communication Barriers
Settlement Barriers
Self-Managing Health/Diabetes
Introduction:
Peer method - Bingo exercise
Facilitator introduces the session, goes through the agenda and
describes the icebreaking bingo exercise
What is peer outreach?
Method: Brain storming and large group discussion
Facilitator writes responses on flip chart and discusses topic using
the handout
Handout: About Peer Outreach
Stress Management
Time: 15 minutes
Barriers to diabetes self-management
Why peer outreach is important in managing chronic disease?
Strategies for addressing barriers to diabetes
self-management
Method: Thought Shower
The Facilitator asks each participant to share ideas and writes them on
a flip chart. Repeat until all ideas have been gathered, discuss with the
group and record the results.
Handout: Seven Models of Peer Support Program to Manage Chronic
Disease, published by California Health Care Foundation.
Relate Peer Support and Peer Outreach:
20
21
Peer ¢ Outreach ¢ Support ¢ Living with Chronic Disease ¢¢ ¢
Share knowledge, emotion, practice and information
Peer Support Models
Time: 20 minutes
How would you build a relationship with people who are isolated
or new to the community?
Method: Large group discussion
The facilitator asks the following questions and records the responses
on the flip chart.
1.We have heard that building a trusting relationship with the Bengali
community is key to building relevant programming. Can you
comment on whether or not this is true in your experience?
2.Do you have any examples of this?
3.What elements have been important for you in building a trusting
relationship, with agencies and community members in general?
Handout: How to build a trusting relationship
Facilitator shares the handout with the group and compares with the
group’s recorded responses.
Time: 25 minutes
How can outreach work best for you?
Method: Individual question
The facilitator asks the following questions and records responses on
the flip chart.
1.We know that outreach is a key element in developing related
programming for the Bengali community. How effective have you found
the outreach strategy to be in engaging you in community activities?
2.Why do you think that outreach is important in general?
3.What are effective ways to reach out to the isolated Bengali
community?
4.Where do you go to access information? Which social events/
gatherings do you attend?
Handout: How to reach the Bengali community and recruit peer
outreach workers Facilitator shares the handout with the group and
compares with the group’s recorded responses.
Time: 30 minutes
22
23
Organizing a meeting/
workshop with the
Bengali community
Module
Objective of the session:
• Participants will learn how to organize a meeting (in formal/
informal settings)
Output of the session:
• How to organize a meeting or workshop in formal or
community setting
How would you recruit participants for the Bengali workshop?
Method: Brain storming
Facilitator invites each participant to write his/her ideas on the flip
chart. Repeat until all ideas have been expressed. Discuss with the
group and screen the responses.
Share from the toolkit “How to reach the Bengali community and
recruit peer outreach workers”, Provide sources of information.
Handouts: How to reach the Bengali community and recruit peer
outreach workers
Time: 20 minutes
How to conduct a meeting/workshop with the Bengali community?
Method: Individual card writing, group demonstration
Facilitator reviews the previous session and creates a flow chart from
there to today’s topic.
How to organize a meeting/workshop. How to choose a meeting/
workshop location. How to set meeting date and time
What would you do to organize a meeting/workshop?
Distribute note cards among participants and ask them to write down
their ideas. Collect the cards and post them on the wall. Read cards
aloud, discuss the topics and establish consensus on priority.
Facilitator shares the toolkit listed below to give concrete ideas.
Handouts: Organizing a meeting/workshop with the Bengali community
Time: 25 minutes
Method: Small group discussion
The Facilitator breaks into small groups (3-4 participants at each group).
Begin with “You are invited to organize a diabetes workshop for the
Bengali community” then ask participants to mention steps they would
take to organize the workshop. Facilitator leads discussion of the list.
Share the toolkit section on “organizing a meeting/workshop with the
Bengali community”, match that information to the recorded responses
from the small groups and discuss.
Handout: organizing a meeting/
workshop with the Bengali
community
Time: 30 minutes
24
25
Communication Barriers
Module
Objective of the session:
• Participants will learn about communication barriers among the
Bengali community and how to overcome them
How do these barriers affect your health?
Method: Demonstration and discussion
Facilitator begins discussion on how barriers affect health. Share
and demonstrate the “Johari Window Model for Collaborative
Learning”. Discuss the quadruple windows from the model and give
examples. Allow time for questions. Relate this learning process to the
communication barriers that participants faced after arriving in Canada.
Output of the session:
• How to reduce communication barriers faced by Bengali community Also relate the effect longstanding barriers can have on personal health.
Handout: Johari Window Model for Collaborative Learning
Time: 30 minutes
What are the key communication barriers that you faced/face
in Canada?
Facilitator Guidelines:
Method: Large group discussion
What information is known by all
Facilitator encourages participants to talk about the barriers to
– What the person knows about him/herself that is also known by
communication they faced when they arrived in Canada. Write down
all the group’s barriers on the flip chart and identify the key barriers
through group discussion. Share key barriers from the toolkits.
Handout: Barriers faced by the Bengali community
Time: 30 minutes
others – open area, open self, free area, free self or ‘the arena’
What you know but others do not know
– What the person knows about him/herself that others do not know –
hidden area, hidden self, avoided area, avoided self or ‘facade’
What others know but you don’t know
– What is unknown to the person about him/herself but which others
Why are these the key barriers for you?
know – blind area, blind self or ‘blindspot’
Method: Card writing
What you and others both don’t know
Facilitator distributes cards and asks participants why these barriers are
– What is unknown to the person about him/herself and is also
the key ones. Collect all cards and post on the board/wall. Read them
unknown by others – unknown area or unknown self
aloud and ask for explanations, if any. Facilitate the discussion and try
to establish a consensus on the reasons for these barriers. Share the
reasons for communication barriers included in the toolkit.
Facilitator draws the conclusion that a good communicator needs to
be a good listener, observer, organizer and to communicate clearly.
Handout: Barriers faced by the Bengali community
Also a facilitator must use simple language, repeat if necessary, insure
Time: 30 minutes
that others understand the message, be aware of cultural differences in
communication and minimize distractions.
26
27
A Model for
Collaborative Learning.
events are focused,
Perfect Knowledge.
purposeful and have
As you share information with the group, and as the group shares
specific agendas. You’ll
information with you, the “Known by All” window increases to where
listen. You’ll share. And
The Johari Window
it is the only quadrant in the Johari Window—a point called “perfect
you’ll learn from other
model is a simple and
knowledge.” When you achieve this level, you and the group, know
business leaders, while
useful tool for illustrating
everything about the subject.
they learn from you.
and improving self-
Knowledge as possible. And by doing so, we give you the tools and
awareness, and mutual
This is the start of a
understanding between
This is the start of
group. The Johari
finding answers and
Window model can
balance. This is the
also be used to assess
start of something
Quadrant 1: Known by All.
extraordinary. Welcome
groups. The Johari
This is the knowledge that is common to everyone. For example, in
to Peer Circles.
Window model was
an office, everyone probably knows how to turn on their computer or
devised by American
answer their phone. In this situation, you do not learn anything new,
psychologists Joseph
but you can use your common experiences to strengthen interpersonal
Luft and Harry Ingham in
relationships.
relationship with other
resources you need to successfully grow your business.
new way of learning.
individuals within a
and improve a group’s
The purpose of Peer Circles is to bring you as close to Perfect
1955, while researching
group dynamics at the
University of California
Los Angeles.
Quadrant 2: Known by You.
This is the specific knowledge that you know but others do not. In our
office setting example, you may be the only person who knows how to
order office supplies online. This is known to you but no one else.
The Johari Window
is a theory on group
learning. In the context
Quadrant 3: Known by Others.
of Peer Circles, it says
This is knowledge not known by you, but known by others. Once again,
that with any given
in our office example, you may not know how to use the copier while
subject, the incredible
other workers do.
amount of collective
knowledge between
you and any group
of people can be
broken down into four
quadrants, or the Johari
Window. Peer Circles
28
Quadrant 4: Unknown.
This is knowledge not known by you or others. Again, in our office
example, it may be that no one knows how to use PowerPoint. However,
by identifying this area, you and the group will know in which areas
you’ll need to look for outside help in order to answer.
29
Settlement Barriers
Cultural differences between Canadian and Bengali communities
Method: Visual demonstration
Module
Objective of the session:
Facilitator shows participants the Geert Hoffstede Cultural Dimensions.
• Participants learn the differences between Canadian and Bengali
Begin a discussion of the dimensions and help participants relate them
culture and identify the barriers to settlement
Output of the session:
• Understanding about the cultural differences and how to cope with
to their own experiences. Repeat those dimensions and discuss about
the key differences.
Handout: Geert Hoffstede Cultural Dimensions
Time: 30 minutes
these differences
Notes: Gerard Hendrik Hofstede (born 3 October 1928, Haarlem)
What are the key barriers to settling in Canada?
How did/do you overcome these barriers? is an influential Dutch organizational sociologist, who studied the
interactions between national cultures and organizational cultures. He
is also an author of several books including Culture’s Consequences
Method: Large group discussion
and Cultures and Organizations, Software of the Mind, co-authored
Facilitator encourages participants to discuss barriers they face or
with his son Gert Jan Hofstede. Hofstede’s study demonstrated that
faced. List all barriers on the flip chart and determine the key barriers
there are national and regional cultural groupings that affect the
through group discussion. Share key barriers from the toolkit.
behaviour of societies and organizations, and that these are
Facilitator asks participants about their strategies for overcoming the
persistent across time.
key barriers. List strategies on the flip chart and discuss them. Share
initiatives taken from the toolkit.
What resource centres or agencies do you usually visit to get
Handout: Barriers faced by the Bengali community
settlement services?
Time: 40 minutes
Method: Sharing information
Facilitator asks participants where they usually go when they need
What barriers do newcomers face when looking for a job?
any settlement related information. Share the available list of
What is Canadian etiquette at work?
settlement agencies.
Method: Share information
Time: 10 minutes
Facilitator shares the information from Settlement.Org and refers to
their website for any settlement-related questions.
Handout: www.settlement.org - Barriers for newcomers when looking
for a job
Time: 20 minutes
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Geert Hofstede™
Cultural Dimensions
Individualism (IDV) on the one side versus its opposite, collectivism,
that is the degree to which individuals are inte-grated into groups.
On the individualist side we find societies in which the ties between
individuals are loose: everyone is expected to look after him/herself
and his/her immediate family. On the collectivist side, we find societies
Canada has Individualism (IDV) as the highest ranking (80) Hofstede
in which people from birth onwards are integrated into strong,
Dimension, and is indicative of a society with a more individualistic
cohesive in-groups, often extended families (with uncles, aunts
attitude and relatively loose bonds with others. The populace is
and grandparents) which continue protecting them in exchange for
more self-reliant and looks out for themselves and their close family
unquestioning loyalty. The word ‘collectivism’ in this sense has no
members. Privacy is considered the cultural norm and attempts at
political meaning: it refers to the group, not to the state. Again, the
personal ingratiating may meet with rebuff.
issue addressed by this dimension is an extremely fundamental one,
Among high IDV countries, success is measured by personal
regarding all societies in the world.
achievement. Canadians tend to be self-confident and open to
discussions on
Power Distance Index (PDI) that is the extent to which the less
general topics;
powerful members of organizations and institutions (like the family)
however, they hold
accept and expect that power is distributed unequally. This represents
their personal privacy
inequality (more versus less), but defined from below, not from above.
off limits to all but
It suggests that a society’s level of inequality is endorsed by the
the closest friends.
followers as much as by the leaders. Power and inequality, of course,
are extremely fundamental facts of any society and anybody with some
international experience will be aware that ‘all societies are unequal,
but some are more unequal than others’.
Masculinity (MAS) versus its opposite, femininity, refers to
the distribution of roles between the genders which is another
India has Power Distance (PDI) as the highest Hofstede Dimension for
fundamental issue for any society to which a range of solutions are
the culture, with a ranking of 77 compared to a world average of 56.5.
found. The IBM studies revealed that (a) women’s values differ less
This Power Distance score for India indicates a high level of inequality
among societies than men’s values; (b) men’s values from one country
of power and wealth within the society. This condition is not necessarily
to another contain a dimension from very assertive and competitive
subverted upon
and maximally different from women’s values on the one side, to
the population, but
modest and caring and similar to women’s values on the other. The
rather accepted by
assertive pole has been called ‘masculine’ and the modest, caring pole
the population as a
‘feminine’. The women in feminine countries have the same modest,
cultural norm.
caring values as the men; in the masculine countries they are somewhat
assertive and competitive, but not as much as the men, so that these
countries show a gap between men’s values and women’s values.
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Uncertainty Avoidance Index (UAI) deals with a society’s tolerance for
uncertainty and ambiguity; it ultimately refers to man’s search for Truth.
Settlement.Org
It indicates to what extent a culture programs its members to feel either
uncomfortable or comfortable in unstructured situations. Unstructured
situations are novel, unknown, surprising, different from usual.
Uncertainty avoiding cultures try to minimize the possibility of such
situations by strict laws and rules, safety and security measures, and on
the philosophical and religious level by a belief in absolute Truth; ‘there
can only be one Truth and we have it’. People in uncertainty avoiding
What barriers do newcomers face when looking for a job?
Most of the barriers listed below come from research done with
employers, and from the experiences of some newcomers. Some
specific issues that Canadian employers have indicated they find
with newcomers:
countries are also more emotional, and motivated by inner nervous
• Lack of fit
energy. The opposite type, uncertainty accepting cultures, are more
• Language and communication barriers
tolerant of opinions different from what they are used to; they try to
• Unfamiliarity with the “Canadian way”
have as few rules as possible, and on the philosophical and religious
level they are relativist and allow many currents to flow side by side.
• Lack of recognition of foreign credentials and work experience
People within these cultures are more phlegmatic and contemplative,
• Licensing issues
and not expected by their environment to express emotions.
• Training and upgrading
• Different standards for performance
Long-Term Orientation (LTO) versus short-term orientation: this fifth
• Racism and discrimination
dimension was found in a study among students in 23 countries around
• Ignorance
the world, using a questionnaire designed by Chinese scholars It can
be said to deal with Virtue regardless of Truth. Values associated with
• Inability to verify foreign work experience
Long Term Orientation are thrift and perseverance; values associated
• Lack of experience working in Canada
with Short Term Orientation are respect for tradition, fulfilling social
• Lack of knowledge of local labour market information (for example,
obligations, and protecting one’s ‘face’. Both the positively and the
negatively rated values of this dimension are found in the teachings of
Confucius, the most influential Chinese philosopher who lived around
500 B.C.; however, the dimension also applies to countries without a
Confucian heritage.
employers, companies, hidden job market)
• Lack of knowledge of support services in the community
• Lack of knowledge of workplace rights
• Misinformation (for example, from friends, family, community,
service providers)
• Inability to present yourself effectively to employers
• Lack of child care
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Employers have some
Advantages to Hiring Immigrants
of their own insights
• Hardworking
about the advantages
and disadvantages
• Good work attitude, respectful
of hiring newcomers
• Loyal
(these come from this
• Often highly skilled
report). It is useful to
• Create a more diverse workplace
know what employers
are thinking about you.
Many employers think:
Self management of diabetes
and other chronic diseases
• New ideas
• Flexible - will work shifts that are hard to fill
• Will work for less money, initially
Module
Objective of the session:
• Participants share their health self-management practices
Output of the session:
• Understanding of health or diabetes self-management practices
and beliefs
• Help to serve clients in different languages
Facilitator reviews the previous session and makes a flow chart that
Barriers to Hiring Immigrants
leads to today’s topic
• Language, language, language! (Comprehension, writing, speaking/
listening, reading)
• Lack of experience with Canadian work culture and business
etiquette
• Temporary: want to go to other Canadian cities
What do you do to keep yourself healthy or prevent sickness?
Method: Card writing
Facilitator distributes cards among participants and asks what they do
to stay healthy. Collect cards and post them on the board/wall. Read
• Not able to work in a team
them aloud and ask for explanations, if any. Share the information from
• Frustration with being overqualified for their jobs
the toolkit.
• Cultural differences/misunderstanding: holidays, language, way of
Handouts: Common health beliefs and practices of Bengali community
dressing themselves, religion
Time: 20 minutes
• Sexism
• Harder to integrate into working teams
Challenges and successes in managing health/diabetes
• Harder to assess skills/qualifications
Method: Share information
Facilitator leads discussion of challenges in managing health or
diabetes with participants. Also discuss the success methods of health
management. Encourage participants to practice some or all of these
methods in order to reduce the negative effects on their health.
Handout: Challenges in managing healthy life
Time: 15 minutes
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Stress Management
Statements:
1. “I only seek medical care in acute situations.”
2. “Physician is managing my diabetes and will fix the problem.”
3. “I don’t have enough time to worry about my own health.”
4. “Changing my practices will not make much of a difference.”
Module
Objective of the session:
• Participants share their stress management techniques and learn
how to deal with stress
5. “Stress is related to financial insecurity and settlement issues.”
Method: Reading and recording responses
Output of the session:
Facilitator reads statements one-by-one and asks participants for their
• How to cope with stress
reactions. Record responses on the flip chart. Share health beliefs and
practices from the toolkit.
Facilitator reviews the previous session and makes a flow chart leading
Handout: Common health beliefs and practices of Bengali community
to today’s topic.
Time: 30 minutes
What is your stress index? What do your scores mean? How would we overcome these mental barriers?
Method: Stress Index Test
Method: Large group discussion
Facilitator distributes the stress index sheet for participants to
Facilitator invites participants to discuss the mental barriers. Encourage
complete. Read from the CMHA booklet “Coping with stress’. Use the
sharing of ideas on how to overcome mental barriers. Record answers
booklet to explain what the participants’ scores mean.
on the flip chart. Share ways to address mental barriers.
Time: 20 minutes
Handout: Common health beliefs and practices of Bengali community
Time: 15 minutes
What are your stressors? Method: Card writing
Health Resources
Facilitator distributes cards among participants and asks to write down
Facilitator asks participants to identify available resources such as
the circumstances that cause them stress. Collect cards and post
hospital, health centre, doctor’s office etc. and records them on the
on the board/wall. Read them aloud and ask for explanations, if any.
paper. Also encourage to share this information with friends and
Facilitate the discussion to find out common stressors and list them.
neighbours.
Time: 15 minutes
Time: 15 minutes
How do you cope with your stress?
Method: Individual questions
Facilitator asks individuals about their coping strategies. Record them
on the flip chart. Share tips for dealing with stress and tension from
the ‘Coping with stress’ booklet. Allow time for participants to feel
comfortable in responding.
Time: 30 minutes
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Barriers to Self-management
of Diabetes and Other
Chronic Diseases
Stages of stress
Ask participants how they feel when they are tense. Help them to
discuss both mental and physical feelings. Using the booklet, share
the three “stages of stress” and explain how each stage works. Relate
those stages to their real experiences.
Time: 20 minutes
Effects on health
Module
Objective of the session:
• Participants explore common barriers to self-managing diabetes
and other chronic diseases.
Facilitator requests volunteers to read “Effect on health” out loud from
the booklet. Open a discussion on the long-term effects of stress on
health. Give participants opportunity to release their tension.
Output of the session:
Time: 15 minutes
• Understanding the various barriers to self-management and ways to
Easy ways to take the pressure off yourself
Method: Demonstration and discussion
overcome them
Facilitator reviews the previous session and makes a flow chart that
leads to today’s topic
Mention 5 types of coping skills and demonstrate the physical skills,
following the booklet. Describe the other 4 types - mental, social,
diversions, spiritual.
Self management behaviours
Time: 30 minutes
What are some ways that people can help manage their own
How to prevent stress?
Facilitator asks participants to write down their answers on the board
or flip chart. Describe how ‘Make decisions, Avoid procrastination, and
Delegate responsibilities’ can help reduce or avoid stress. Give some
example from the toolkit.
Time: 15 minutes
Handouts: Coping with stress from CMHA.
diabetes?
Method: Brainstorm
Facilitator asks participants to list ideas people can use to self-manage
diabetes and other chronic diseases. Responses are written on the flip
chart. When all ideas have been gathered, sheets are taped to the wall
and discussed. .
Time: 15 minutes
Barriers
What are the barriers to self-management that people face?
Method: Brainstorm
Facilitator asks participants to list the barriers that prevent people from
taking steps towards self-managing their diabetes and other chronic
diseases and writes responses on flip chart. Facilitator encourages
ideas until as many as possible have been gathered, including asking
questions. For example, if discomfort with going to a gym isn’t
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mentioned, the facilitator should ask participants if there are any
barriers to going to the gym. After participants have supplied all there
Types of Barriers
ideas, facilitator fills in any barriers that are missing.
Handout: Types of barriers
1. Familiar
Time: 15 minutes
• These barriers relate to the uncertainty people feel when they
are unfamiliar with the steps and behaviours that could lead to
Why are these barriers to self-management?
Method: Large group discussion
improved health.
• New foods and new ways of cooking, going to places they haven’t
been before, doing new kinds of exercise at a gym, having to wear
Facilitator leads a discussion about the different types of barriers that
Western-style gym clothing can all be unfamiliar and, as a result,
exist, asking participants why these barriers belong on the list. Facilitator
people tend to avoid doing them.
explains each barrier, lists them on flip chart and leads discussion
about why these barriers belong where they have placed. Explain that
understanding the types of barriers they may encounter is helpful.
2. Relevant
Handout: Types of barriers
• Other issues and priorities in people’s lives may take precedence
Time: 20 minutes
over self-care. For example, finding a job, taking care of one’s
family and accessing settlement services may all take priority over
managing one’s health.
What are some ways to overcome these barr1ers?
• These other priorities may prevent people from taking care of their
Method: Go-Around
health because health is not considered to be as important as other
Facilitator asks participants to think of a conversation they’ve had with
priorities.
a neighbour, friend or acquaintance in which the person expressed a
barrier to self-management. For example, a neighbour may have said
that she doesn’t have enough time to visit a doctor about her diabetes.
3. Manageable
• If taking care of oneself is not considered manageable on a
Go around the room and ask each participant to share the conversation
day-to-day basis, it may prevent people from looking after their
they’ve had. Ask the rest of the group to determine what category of
health properly.
barrier this conversation fits into.
• A common barrier to good health is that even people who try to
do more physical exercise, or eat the right foods can find it hard to
Method: Role Play
Facilitator forms participants into pairs. Each pair picks one
conversation of the two they just shared. Participants act out a scenario
manage a new exercise regime or diet and give up.
• Addressing such barriers should focus on finding manageable ways
for people to work their way up to the goal of healthy living slowly.
in which a peer outreach worker meets a client who expresses this
barrier and the peer outreach worker suggests a strategy to help
overcome the barrier.
Handout: Types of barriers
Time: 40 minutes
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Strategies for Addressing
Barriers to Self-management
of Diabetes and Other
Chronic Diseases
Module
Objective of the session:
• Participants learn ways to address barriers that prevent people from
successfully managing their diabetes and other chronic diseases
Output of the session:
• Participants understand ways to overcome barriers to self-
4. Credible
• To improve self-care, people need to believe that they change is in
their best interest, and be confident about the relevant information
they are getting.
management of diabetes and other chronic diseases
Facilitator reviews the previous session and makes a flow chart that
leads to today’s topic.
• Sometimes there are barriers to accepting information, such as if
the source of the is not considered credible.
• Credible sources include people who are trusted and respected
What types of barriers were discussed in the last session?
Method: Brainstorm
within the community and who are acknowledged to have skills and
Facilitator lists five categories of barriers on separate pieces of paper
expertise.
and asks participants to name the barriers that fit under each category.
Facilitator fills in any that are missed by the group. If participants list
5. Accessible
• Barriers that fall within this category include language barriers,
transportation barriers and financial barriers.
• These are all practical barriers that prevent people from seeking
any barriers that weren’t mentioned last time have the group discuss
which category these barriers belong to.
Handout: Types of barriers
Time: 15 minutes
programs and advice to help them with their diabetes.
What are some strategies that can be used to address
these barriers?
Method: Brainstorm
Facilitator goes through the categories and asks participants how
programs or individuals could address these barriers, writing responses
on flip chart. Facilitator encourages responses by offering suggestions
as necessary.
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Handout: Strategies for addressing barriers to self management of
diabetes and other chronic diseases
Time: 35 minutes
How do these strategies work?
Method: Role Play
Facilitator forms participants into pairs and hands each pair a sheet
with a different strategy identified on it. Each pair acts out a scene in
which a peer outreach worker tries to connect a client with resources.
Strategies for addressing barriers
to diabetes self management
1. Familiar
• Provide peer support in group settings
• Provide one-on-one support
• Peers accompany people to health appointments
• Peers offer support and intervention when required
The client resists due to the presence of a barrier and the outreach
worker uses a strategy to address the barrier. At the end of each scene
the group discusses whether the scene reflects a real situation they’ve
encountered; other strategies that could be used in this situation; other
barriers that could be addressed by this strategy and if the strategy
would be easy or difficult to use in real life.
Handout: Strategies for addressing barriers to self management of
diabetes and other chronic diseases
Time: 30 minutes
How would you use these strategies to overcome barriers to
self-management?
Method: Small group discussion
Facilitator asks participants to form into groups of three or four
and assigns one or two strategies to each group. Help groups in
2. Relevant
• D
eliver messages that show how diabetes self-management helps
support other important priorities
• P
rovide peer support that addresses issues such as employment
and housing
3. Manageable
• Provide culturally appropriate exercise opportunities
• Provide in-home exercise options
• O
ffer educational programs about diet that acknowledge cultural
preferences
• R
ecommend the incremental adoption of self-care behaviours
(gradual increases in exercise, gradual decreases in unhealthy food,
vigorous positive feedback on progress)
discussesing following questions:
Can you give an example of this strategy from your experience?
In what situation(s) might you use this strategy?
4. Credible
Would this strategy be difficult or easy to use?
• P
rovide information from sources that people will find credible and
in whom they have confidence (e.g. experts, prominent leaders)
Are there other strategies that you would want to use with this one?
• Provide peer reinforcement of expert information
Groups present findings to the rest of the participants.
Handout: Strategies for addressing barriers to self management of
5. Accessible
diabetes and other chronic diseases
• Provide culturally appropriate support
Time:30 minutes
• P
rovide linguistically appropriate information and programs at
various locations
• Provide programs that subsidize transportation and child-care
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