":VÄH+HUPLSH-LYYLPYH4HY[PUZ"4HY[H:VÄH+VYLZKH:PS]H 1 Bern University of Applied
Sciences, Health Division, R&D in Nutrition and Dietetics, Murtenstrasse 10, CH-3008 Bern, Switzerland
2 Faculty of Nutrition and Food Sciences of the University of Porto, Rua Dr. Roberto Frias, 7VY[V7VY[\NHS
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Leila Sadeghi Bern University of Applied Sciences, Health Division, R&D in Nutrition and Dietetics, Murtenstrasse 10, CH-3008 Bern, Switzerland leila.sadeghi@bfh.ch
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9LJLIPKVHKLV\[\IYVKL Aceite a 30 de março de 2017
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The Tamil population is one of the largest migrant groups living in Switzerland and presents a high prevalence of gestational diabetes. The changes in dietary patterns due to migration are often underestimated in dietetics counseling. The project 5\[YP.L+MYVT)LYU<UP]LYZP[`VM(WWSPLK:JPLUJLZHPTLKH[KL]LSVWPUN[OLÄYZ[VѝJPHS[VVS[OL¸4PNTHWW©¹PU:^P[aLYSHUK[VOLSW OLHS[OJHYLWYVMLZZPVUHSZJV\UZLSPU[OLTVZ[LѝJPLU[THUULY[OLPYNLZ[H[PVUHSKPHIL[LZWH[PLU[ZVM;HTPSVYPNPU
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The aim of the present study was to assess the perceptions regarding the clarity and usefulness of the MigMapp©»Z tools among Tamil migrant women living in Switzerland.
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(:\Y]L`4VURL`IHZLKX\LZ[PVUUHPYL^HZKL]LSVWLKPU.LYTHUHUK[YHUZSH[LKPU[V;HTPS/HYKJVWPLZVM[OL survey were distributed to 100 Tamil women living in Switzerland. The completed surveys were manually collected and inserted into SurveyMonkey by NutriGeD team members and analyzed using SPSS and Excel.
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VM[OLWHY[PJPWHU[ZOHKILLUSP]PUNPU:^P[aLYSHUKMVYTVYL[OHU`LHYZHUKOHKHSYLHK`ILLUKPHNUVZLK^P[O NLZ[H[PVUHSKPHIL[LZ;OLTHQVYP[`VMYLZWVUKLU[ZU$JVUZPKLYLK[OL4PNTHWW© to be complete in terms of providing the necessary information on the topic of dietetics and exercise tips for gestational diabetes. Both tools rated as the most understandable included a series of depicted visuals with respectively descriptive or instructional text. Helpfulness of using visuals was also shown by the high rating of the diabetic-friendly recipes, each including a photographed standard portion of the menu.
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Overall, the Migmapp© was well accepted among the Tamil women participating in this evaluation survey and considered to be a good provider of lifestyle tips in case of gestational diabetes. The Migmapp©^PSSILM\Y[OLY[LZ[LKMVYP[ZLѝJHJ`
and if proven successful, the developed materials will be made available, and developed for other migrant groups.
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Dietetics counseling, Gestational diabetes, Migration, Tamil, Tool
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O presente estudo teve como objetivo avaliar as perceções relativamente à clareza e utilidade das ferramentas do Migmapp© LU[YLT\SOLYLZTPNYHU[LZ;oTPSYLZPKLU[LZUH:\xsH
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KVZWHY[PJPWHU[LZ]P]LTUH:\xsHOmTHPZKLHUVZL[PUOHTZPKVQmKPHNUVZ[PJHKVZJVTKPHIL[LZNLZ[HJPVUHS (THPVYPHKHZYLZWVUKLU[LZU$JVUZPKLYHYHTV4PNTHWW© completo, em termos de fornecimento de informação necessária no X\LKPaYLZWLP[VHKPJHZWHYHJVU[YVSHYHKPHIL[LZNLZ[HJPVUHS[HU[VU\[YPJPVUHPZJVTVKLL_LYJxJPVMxZPJV(ZMLYYHTLU[HZJSHZZPÄJHKHZ JVTVHZTHPZJVTWYLLUZx]LPZPUJS\xHT\THZtYPLKLPTHNLUZKLZJYP[P]HZJVTVYLZWL[P]V[L_[VKLZJYP[P]VV\PUZ[Y\[P]V6WVKLYKL HQ\KHKLPTHNLUZMVP[HTItTKLTVUZ[YHKVWLSHLSL]HKHJSHZZPÄJHsqVKHZKPL[HZVYPLU[HKHZWHYHWLZZVHZKPHIt[PJHZ\TH]LaX\L JHKH\THPUJS\xH\THMV[VNYHÄHKL\THWVYsqVYLMLYvUJPHKVTLU\
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Em geral, o Migmapp©MVPILTHJLP[LLU[YLHZT\SOLYLZ[oTPSLZX\LWHY[PJPWHYHTUHZ\HH]HSPHsqVH[YH]tZKLZ[L X\LZ[PVUmYPV[LUKVZPKVJVUZPKLYHKV\TIVTMVYULJLKVYKLPUMVYTHsLZZVIYLVLZ[PSVKL]PKHHHKV[HYLTJHZVKLKPHIL[LZ gestacional. O Migmapp©ZLYm[HTItT[LZ[HKVUVX\LKPaYLZWLP[VnLÄJmJPHLZLUKVILTZ\JLKPKVVZTH[LYPHPZZLYqV[HTItT disponibilizados e desenvolvidos para outros grupos migrantes.
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Consultas de nutrição, Diabetes gestacional, Migração, Tâmil, Ferramenta
PERCEÇÃO DAS MULHERES MIGRANTES TÂMIL DE UMA FERRAMENTA ALIMENTAR TRANSCULTURAL PARA ACONSELHAMENTO NA DIABETES GESTACIONAL
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source: https://doi.org/10.24451/arbor.6146 | downloaded: 9.12.2019
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By the end of 2014, the foreign resident population in Switzerland was about two million people and Sri Lanka was among the main countries applying for asylum (1), which is not surprising considering that the Sri Lankan diaspora represents one of the largest migrant groups in Switzerland (2). Since 1980, the Tamil population has been migrating from Tamil Nadu as well as Eastern Sri Lanka (2). Today, approximately 50.000 Tamils live in Switzerland (3) and one of the main reasons why this group started migrating to Switzerland in such large numbers more [OHU`LHYZHNV^HZ[VÅLL[OLJP]PS^HYPU:YP3HURH-VYLJHZ[Z WYLKPJ[[OH[;HTPSTPNYHU[Z^PSSJVU[PU\L[VÄUKYLM\NLPU:^P[aLYSHUK in the next years (2). It is therefore important to gain knowledge about this population living in Switzerland, and ensure to provide a culturally competent healthcare service.
:[\KPLZOH]LZOV^U[OH[TPNYH[PVUJHUOH]LHZPNUPÄJHU[PUÅ\LUJL VUOLHS[OV\[JVTLZHUK[OH[IHYYPLYZZ\JOHZPUZ\ѝJPLU[SHUN\HNL knowledge can significantly affect the communication between patient and healthcare professional, therefore impairing healthcare VMTPNYHU[Z0UHKKP[PVURUV^SLKNLVMZPNUPÄJHU[OLHS[OPZZ\LZ which Tamil migrants encounter helped narrow down the project.
Data indicate that the Tamil population in Switzerland presents a high prevalence of gestational diabetes and type 2 diabetes, most likely due to a combination of genetics and a new lifestyle (2). Data indicate that approximately 18% of this at-risk population is diagnosed with gestational diabetes (5) while the general prevalence worldwide is IL[^LLUHUK
;VKH[L[OLYLPZUVVѝJPHSH]HPSHISL[VVS[OH[JVUZPKLYZ[OLLH[PUN and physical activity habits of the migrant Tamil population living in Switzerland. This gap may jeopardize a successful communication
^P[OTPNYHU[WH[PLU[Z\S[PTH[LS`KLJYLHZPUN[OLX\HSP[`VM[OLWYV]PKLK OLHS[OJHYLHUKSPTP[PUN[OLHKLX\HJ`VM[OLYHW`0UVYKLY[VJSVZL[OPZ gap and enhance the cooperation between healthcare professionals and patients within the scope of consultations, the NutriGeD team (Nutritional Gestational Diabetes) developed a series of material as part VMHMVSKLYJHSSLK¸4PNTHWW©¹PUJS\KPUN[VVSZ[VLHZL[OLJVUZ\S[H[PVU process, increase transcultural competence, sensitize nutritionists, dietitians, diabetes consultants as well as other employees in the healthcare system to the special needs of migrant populations, in this case, the Tamil.
The NutriGeD project was led by Bern University of Applied Sciences PU:^P[aLYSHUKHUKJHYYPLKV\[[VNL[OLY^P[OKPќLYLU[WHY[ULYZHUK Z[HRLOVSKLYZMYVTLK\JH[PVUHUKJSPUPJHSÄLSKZHZ^LSSHZ[OL:^PZZ Diabetes Organization and the Tamil Association of Northwestern Switzerland. It included collaboration of nutrition scientists, dietitians, nurses and midwives.
The development of the Migmapp© prototype was achieved by the end of November 2015. Topics covered in the MigMapp© included the pathophysiology of gestational diabetes, transcultural competence, ZWLJPMPJHSS` PU YLNHYKZ [V [OL ;HTPS WVW\SH[PVU :YP 3HURH»Z socio-political aspects, eating and physical activity habits and preferences (both traditional and new) of the Tamil population, as well as a set of bilingual info materials (German and Tamil) to be used in consultations and which covered diet and exercise topics ZWLJPÄJHSS`PU[OLJHZLVMHNLZ[H[PVUHSKPHIL[LZ;OL4PNTHWW© comprises a handbook and a stand-up display. The handbook is directed to healthcare professionals in order to foster their transcultural JVTWL[LUJLZWLJPÄJHSS`PUYLNHYKZ[V[OL;HTPSWVW\SH[PVU^OPSL VMMLYPUNHX\PJRV]LY]PL^VMNLZ[H[PVUHSKPHIL[LZHUKZ[HUKHYK dietetics management procedures. The stand-up display consists of seven tools, developed in German and Tamil, including:
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¸>OH[KVLZNLZ[H[PVUHSKPHIL[LZTLHU&¹+LZJYPW[PVUVM the disease including risk factors, development of hyperglycemia, JVUZLX\LUJLZMVYTV[OLYHUKJOPSKHUKTHUHNLTLU[[YLH[TLU[VW[PVUZ"
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¸;HTPS]LYZPVUVM[OLMVVKW`YHTPKMVYWYLNUHU[^VTLU^P[O NLZ[H[PVUHSKPHIL[LZ¹!*VTIPUH[PVUVM[OL;HTPSMVVKW`YHTPKYLJLP]LK from the Tamil Association of Northwestern Switzerland, with the Swiss :VJPL[`VM5\[YP[PVU:.,»ZU\[YP[PVUHSYLJVTTLUKH[PVUZMVYWYLNUHU[
women;
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¸/LHS[O`LH[PUNWSH[L\ZPUN;HTPSMVVK¹!*YLH[PVUVMHOLHS[O`
eating plate based on the nutritional recommendations of the Swiss Society of Nutrition SGE and traditional Tamil food;
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¸,H[PUNOLHS[O`^P[ONLZ[H[PVUHSKPHIL[LZ!KPL[P[PHUHWWYV]LK YLJPWLZ¹!;YHKP[PVUHSYLJPWLZJVTIPUPUN;HTPSMVVKZ^OPSLJVUZPKLYPUN [OLKPL[HY`PU[HRLYLX\PYLTLU[ZPUJHZLVMNLZ[H[PVUHSKPHIL[LZ"
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¸>OPJO]LNL[HISLZNYV^PU:^P[aLYSHUK&¹!*VSSLJ[PVUVMJVTTVU vegetables available in Switzerland followed by a short explanation on how to prepare them. This tool was created based on results from a previous focus group within the NutriGeD study, where Tamil participants mentioned that they did not always know about vegetables found in Swiss supermarkets nor how to prepare them;
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from Bern University of Applied Sciences showing a series of pictures with activities of everyday life that are health promoting or not, e.g. take the stairs instead of using the elevator;
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¸/V^T\JOZ\NHYPZPUT`MVVK&¹(JOHY[KPZWSH`PUNWVW\SHYMVVK P[LTZZ\JOHZJOVJVSH[LMY\P[`VNO\Y[HUKMY\P[ZHUK[OLLX\P]HSLU[VM sugar amount represented by sugar cubes, as well as a picture explaining
^OLYL[VYLHK[OLZ\NHYJVU[LU[^OLUSVVRPUNH[HWYVK\J[»ZSHILS Both handbook and stand-up display were developed considering user- friendly formats. They were both meant to provide essential information PUHX\PJRPU[\P[P]LHUKLHZ`[VYLHKTHUULY
;OLJOHW[LYZ»JVU[LU[ZPU[OLOHUKIVVR^LYLLZ[HISPZOLKI`[OL NutriGeD research team, and their pertinence was confirmed by Z\Y]L`LKOLHS[OJHYLWYVMLZZPVUHSZMYVT[OLÄLSKZVMTLKPJPULU\YZPUN dietetics and diabetes counseling who dealt with the presented topics in their daily practice.
;OLOHUKIVVRÄYZ[MVJ\ZLZVUNLZ[H[PVUHSKPHIL[LZHUKTLYNLZVU topics covering transcultural competence in general, and transcultural competence when counseling Tamil migrants in particular. This way, healthcare professionals are provided with a clear overview of the condition they have to deal with as well as how they can optimally use transcultural competence in order to achieve an optimal counseling.
;OLOHUKIVVR»Z(MVYTH[HUKYLSH[P]LJVTWHJ[ZPaLPZTLHU[[V encourage its easy usage on a daily basis in practice, in other words
¸VU[OLNV¹HZSP[[SL[PTLPZSLM[MVYYLHKPUN[PTLJVUZ\TPUNSP[LYH[\YL The seven tools included in the stand-up display folder aimed at easing the communication between the healthcare professional and the Tamil WH[PLU[:WLJPÄJHSS`LHZ`[V\UKLYZ[HUKPSS\Z[YH[PVUZHIV\[[OLUV[PVUVM NLZ[H[PVUHSKPHIL[LZHUKWH[PLU[Z»[PWZ[VWYL]LU[P[VYOHUKSLP[VUHKHPS`
basis were provided, in their own language, but also in the healthcare WYVMLZZPVUHS»ZSHUN\HNLPU[OPZJHZLPU.LYTHUZVIV[OJV\SKSVVRH[
the illustrations and fully understand the messages included on each page. For the stand-up display again, the number of tools was limited to essential information covering gestational diabetes, how it develops and
^OH[HYL[OLJVUZLX\LUJLZHZ^LSSHZOLHS[O`LH[PUNHUKL_LYJPZL[PWZ focused on typical Tamil food products while including Swiss products that the patients may want to consider to incorporate in their diet. The stand-up display ends with a series of diabetic friendly menus, which the Tamil women can try at home, including their ingredients and cooking instructions.
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The aim of the present study was to assess the perceptions regarding the clarity and usefulness of the MigMapp©»Z[VVSZHTVUN;HTPS migrant women living in Switzerland, to provide a culturally competent healthcare service.
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;OLX\LZ[PVUUHPYL^HZKL]LSVWLKVUSPULZWLJPÄJHSS`MVY[OPZZ[\K`
\ZPUN:\Y]L`4VURL`0UJ7HSV(S[V*HSPMVYUPH<:(^^^
Z\Y]L`TVURL`JVT 6UJL KL]LSVWLK PU .LYTHU X\LZ[PVUZ were translated in Tamil by the Tamil Association of Northwestern Switzerland, who also functioned as an intermediary to manually KPZ[YPI\[L[OLWYPU[LK]LYZPVUVM[OLX\LZ[PVUUHPYLZ[V;HTPS^VTLU during a major event where were present about 100 women in the Temple. The NutriGeD team agreed on the recruitment of the potential WHY[PJPWHU[ZHUKKPZ[YPI\[PVUVM[OLX\LZ[PVUUHPYLZK\YPUN[OH[KH`
;OLYLMVYLZ\IZLX\LU[S`[V[OL;LTWSL»ZL]LU[HKKP[PVUHS^PSSPUN participants were recruited during visit hours in the Association and HKKP[PVUHSX\LZ[PVUUHPYLZ^LYLOHUKLKV\[[OLYLHZ^LSS;OLZ\Y]L`
was distributed to female participants only, from mid-November 2015 [VTPK1HU\HY`;OLX\LZ[PVUUHPYL^HZÄYZ[KL]LSVWLKVUSPULPU German by the NutriGeD team, then translated in Tamil by the Tamil Association of Northwestern Switzerland and 100 copies were sent to this Association in print format so participants would not have to have HJJLZZ[VPU[LYUL[[VÄSSP[V\[0[^HZRLW[HZZOVY[HZWVZZPISLHUK JSVZLKX\LZ[PVUZ^LYLMH]VYLKV]LYVWLUVULZPUVYKLY[VMHJPSP[H[L ZLSLJ[PVUVMYLZWVUZLZ)LZPKLZHZ[OLX\LZ[PVUUHPYL^HZKPZ[YPI\[LKPU P[Z;HTPS]LYZPVU[OL[YHUZSH[PVUVMYLZWVUZLZ[VVWLUX\LZ[PVUZPU;HTPS
^V\SKOH]LILLUH[PTLJVUZ\TPUNHUKKPѝJ\S[WYVJLZZ0[[OLYLMVYL PUJS\KLKX\LZ[PVUZVM^OPJO^LYLJSVZLKHUK[^VVWLU0[
JVTWYPZLKZVJPVKLTVNYHWOPJPUMVYTH[PVUX\LZ[PVUZMHTPSPHYP[`HUK L_WLYPLUJL^P[ONLZ[H[PVUHSKPHIL[LZX\LZ[PVUZHUKX\LZ[PVUZ pertaining to personal opinion on the understandability and helpfulness of the seven tools contained in the stand-up display and possible issues not covered by them using the 5-point Likert scale (1-Not at all, 2- Barely, 3- Moderately, 4- Very much, 5- Extremely). Participation was voluntary and anonymous. Consent was considered given if the YLZWVUKLU[JVTWSL[LKHUKYL[\YULK[OLX\LZ[PVUUHPYL
;OLHUZ^LYLKX\LZ[PVUUHPYLZ^LYLHUHS`aLK\ZPUN:\Y]L`4VURL`
HUK0)4® SPSS® Statistics 23.0 (2015) as well as Microsoft 6ѝJL,_JLS
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^LYLHUHS`aLKHZ[^VX\LZ[PVUUHPYLZ^LYLYL[\YULKISHURHUKVUL was partially completed (response rate 25%). Of the 25 participating women, 13 were older than 35 years of age and 10 were aged between 20 and 34 years. 95% of the respondents were originally from Sri Lanka and only one person came from India. 23 respondents were married, while one was single and another one divorced. The majority of the women (80%) indicated to be working whereas three were unemployed, one was retired and one was a homemaker. More [OHUOHSMVM[OLYLZWVUKLU[ZKPKUV[OH]L:^PZZUH[PVUHSP[``L[
while the majority had been living in Switzerland for more than 5 years
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indicated to have basic language knowledge (Table 1).
Characteristics of respondents
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32% of the respondents had been diagnosed with gestational diabetes at least once and 24% knew other Tamil women who had been diagnosed with this condition. As far as preferred type of communication means when it comes to receiving health information and tips, direct communication through healthcare providers was the most selected VW[PVU^P[OVMYLZWVUKLU[Z^OPSLHUKMH]VYLKPU[LYUL[
and brochures, respectively. In this context, smartphone applications only interested 17% of respondents (Data not shown).
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In regards to the evaluation of the Migmapp©, each tool was rated based on [OLMVSSV^PUNMV\YX\LZ[PVUZ!¸/V^LHZ`PZP[[V\UKLYZ[HUK[OPZ[VVS&¹¸/V^
OLSWM\SHYL[OLPTHNLZPU[OPZ[VVSPUVYKLY[V\UKLYZ[HUK[OLPUMVYTH[PVU&¹
¸/V^\ZLM\SPZ[OPZ[VVSMVYPTWSLTLU[PUNJOHUNLZPUL]LY`KH`SPMLPUVYKLY [VJVU[YVSNLZ[H[PVUHSKPHIL[LZ&¹HUK¸/V^T\JOKVLZ[OPZ[VVSYLTLK`[V
`V\YPUMVYTH[PVUULLKZJVUJLYUPUN[OPZ[VWPJ&¹(UZ^LYVW[PVUZJVUZPZ[LK VMHWVPU[3PRLY[ZJHSL¸5V[H[HSS)HYLS`4VKLYH[LS`=LY`
T\JO,_[YLTLS`¹-VYLHJO[VVSH^LPNO[LKH]LYHNL^HZJHSJ\SH[LKWLY L]HS\H[PVUX\LZ[PVUHUKYH[PUNZVM[OLZL]LU[VVSZ^LYLJVTWHYLK-PN\YL
;OL[^VTVZ[\UKLYZ[HUKHISL[VVSZHWWLHYLK[VIL[VVS¸>OH[
KVLZNLZ[H[PVUHSKPHIL[LZTLHU&¹^LPNO[LKH]LYHNLHUK[VVS
¸>OPJO]LNL[HISLNYV^PU:^P[aLYSHUK&¹^LPNO[LKH]LYHNL HUK[OLSLHZ[\UKLYZ[HUKHISL^LYL[VVS¸;HTPS]LYZPVUVM[OLMVVK W`YHTPKMVYWYLNUHU[^VTLU^P[ONLZ[H[PVUHSKPHIL[LZ¹^LPNO[LK H]LYHNLHUK[VVS¸/V^T\JOZ\NHYPZPUT`MVVK&¹^LPNO[LK average 3.32) (Figure 1).
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^P[ONLZ[H[PVUHSKPHIL[LZ!+PL[P[PHUHWWYV]LKYLJPWLZ¹JVU]PUJLKTVZ[
of the participants (with both weighted averages of 3.8) (Figures 1).
As far as usefulness to implement changes in everyday life in order to control gestational diabetes, again, both tools 1 and 4 were rated the OPNOLZ[^LPNO[LKH]LYHNLZVMHUKYLZWLJ[P]LS`-PN\YL Interestingly, the lowest rated tool in terms of usefulness was tool 5, with a weighted average of 3.28, despite it being rated as one of the most understandable of the seven tools.
All tools were highly rated in terms of their instruction potential, tools 4 HUKILPUN[OLOPNOLZ[YH[LKIV[O^P[OH^LPNO[LKH]LYHNLVM -PN\YL4VZ[YLZWVUKLU[ZU$YH[LK[VVS¸/V^T\JO Z\NHYPZPUT`MVVK¹HZ[OLNLULYHSS`TVZ[OLSWM\S[VVSMVSSV^LKI`
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[OLTHQVYP[`VMYLZWVUKLU[ZU$JVUZPKLYLK[OL4PNTHWW© to be complete in terms of providing the necessary information on the topic of dietetics and exercise tips for gestational diabetes.
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Sensitization of healthcare professionals to transcultural competence can improve communication with migrant patients, therefore optimizing healthcare and therapy outcomes. From the obtained results, it is clear [OH[[OLKL]LSVWLKJV\UZLSPUN[VVS¸4PNTHWW©¹^HZ^LSSHJJLW[LK among the Tamil women participating in this evaluation survey and considered to be a good provider of eating and exercise tips in case of gestational diabetes. Both tools rated as the most understandable included a series of depicted visuals with respectively descriptive or PUZ[Y\J[PVUHS[L_[¸>OH[KVLZNLZ[H[PVUHSKPHIL[LZTLHU&¹¸>OPJO ]LNL[HISLNYV^PU:^P[aLYSHUK&¹
Helpfulness of using visuals was also shown by the high rating of the diabetic-friendly recipes, each including a photographed standard portion of the menu, cooked on a workshop by voluntary Tamil women from the Tamil Association of Northwestern Switzerland and members of the NutriGeD team. The usefulness of the tools for implementing changes in everyday life in order to control gestational diabetes correlated with the high rating of tools with visuals and corresponding text. However, the tool introducing to typical vegetables found in Switzerland and preparation tips, once suggested in a focus group with Tamil women in the scope of NutriGeD, was an exception, as it was the least well- rated in terms of usefulness for implementation in daily life, despite it being rated as one of the most understandable tool. To our surprise, this tool, together with the recipes, was rated as remedying the most [V[OLWHY[PJPWHU[Z»PUMVYTH[PVUULLKZ^OLUP[JVTLZ[VLH[PUNOLHS[O`
with gestational diabetes. Possible barriers to using this tool need to be further investigated, and may involve costs and access to the products.
The results hint at a clear necessity to further promote the use of the food W`YHTPKHUKHZ^LSSHZYLHKPUNMVVKSHILSZPU[OPZJHZLZWLJPÄJHSS`MVY sugar content, as both food pyramid and sugar content in foods tools
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,ќVY[ZZOV\SKILTHKL[VPUJYLHZL\UKLYZ[HUKPUNVMOLHS[O`LH[PUN guidelines and applying concepts to personal eating and exercising routine, while providing a cultural competent message.
In terms of communication means, the majority of respondents favored having direct contact with a healthcare professional, highlighting the importance of ensuring optimal communication during the counseling OV\Y-PUHSS`[OL[VVS¸0KLJPKLHJ[P]LS`¹^OPJO^HZKL]LSVWLK[VLUNHNL women to be physically active throughout the day, was considered the least helpful and needs to be optimized. The pictures on that tool PUJS\KLK]PZ\HS[PWZZ\JOHZ¸[HRL[OLZ[HPYZUV[[OLLSL]H[VY¹ A potential limitation for this tool is the lack of corresponding text describing the pictures. Other study limitations include a limited sample size and a rather low response rate (25%), both of which are critical to [OLYVI\Z[ULZZVMYLZ\S[ZHUKHYLZ[YPJ[LKHTV\U[VMX\LZ[PVUZWLY[VVS A larger-scale survey among a representative sample of the Tamil women population in Switzerland, or focus groups with Tamil migrant women including an in-depth analysis of each tool should provide further detailed appreciation of their views concerning the Migmapp©(X\LZ[PVUUHPYL format was preferred over a focus group to increase chances of higher participation rates. In addition, it was translated in Tamil, so language would not be a barrier to participate in the study and therefore more
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One additional limitation of the study is that the experience with pregnancy among participants was not considered. The tools were PUKLLKZWLJPÄJHSS`KLZPNULKMVY;HTPSTPNYHU[Z^P[ONLZ[H[PVUHSKPHIL[LZ
`L[P[^HZKPѝJ\S[[VYLJY\P[JVYYLZWVUKPUNWHY[PJPWHU[ZHUK[OLYLMVYL[OL WHY[PJPWHU[Z»JYP[LYPH^LYLL_[LUKLK[V;HTPSTPNYHU[^VTLUPUNLULYHS It would have been interesting to compare the responses from a woman who was pregnant at the time of the study with one who never had children or that had been pregnant in the past, as this could probably PUÅ\LUJL[OLL]HS\H[PVUHWWYLJPH[PVUHZ^LSSHZPU[LYLZ[MVY[OL[VVSZ -\Y[OLY^VYRZOV\SKZWLJPÄJHSS`HUHS`aL[OLWLYZWLJ[P]LVM[OLWYLNUHU[
women regarding the Migmapp©.
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The Migmapp© was well accepted among the Tamil women participating in this evaluation survey and considered to be a good provider of lifestyle tips in case of gestational diabetes. The Migmapp©VќLYZH novel approach for an optimized transcultural dietetics counseling and might be part of a promising strategy to be used in clinical practice.
The Migmapp© is scheduled to be tested by healthcare professionals [VHZZLZZP[ZLѝJHJ`HUKPMWYV]LUZ\JJLZZM\S[OLKL]LSVWLKTH[LYPHSZ will be made available for clinical visits, in hospital or private practice and further folders will be developed for other migrant groups following a similar approach.
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State Secretariat for Migration (SEM) Switzerland;
Bern University of Applied Sciences (BUAS)
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The authors would like to thank BFH interns Linda Ruch and Sandra Büsser for their invaluable support in the data reporting and analysis phases.
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1. Switzerland: State Secretariat for Migration (SEM), Migration Report 2014, June 2014, available at: https://www.sem.admin.ch/dam/data/sem/publiservice/berichte/
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4VYL[1,ÄVUH`P+:[HU[Z-+PLZYPSHURPZJOL+PHZWVYHPUKLY:JO^LPa)LYU!-LKLYHS 6ѝJLMVY4PNYH[PVU(]HPSHISLH[!O[[WZ!^^^ZLTHKTPUJOKHTKH[HZLT publiservice/publikationen/diaspora/diasporastudie-srilanka-d.pdf [accessed 4 August D
3. 30 Jahre Tamilen in der Schweiz: Schutz der Menschen statt Wegweisungen!
UK (]HPSHISL H[! O[[WZ!^^^NMI]JOKLRHTWHNULUFFFWYVQLR[LZYPFSHURHFF RYPLNZ]LYIYLJOLYFT\ZZLUFZ[YHMYLJO[SPJOF]LYMVSN[F^LYKLUJMT&1HOYL Tamilen-in-der-Schweiz-Schutz-der-Menschen-statt-Wegweisungen [accessed 8 6J[VILYD
4. Rommel A, Weilandt C, Eckert J. Gesundheitsmonitoring der schweizerischen Migrationsbevölkerung: Endbericht. Bonn: Wissenschaftliches Institut der Ärzte +L\[ZJOSHUKZ>0(+
5. Rajput R, Yadav Y, Nanda S, Rajput M. Prevalence of gestational diabetes mellitus
& associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res.
2013;137:728-33.
4L[aNLY),)\JOHUHU;(*V\Z[HU+9+L3LP]H(+\UNLY+)/HKKLU+9 Zoupas C. Summary and Recommendations of the Fifth International Workshop-
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