Type 2 Diabetes Among Asian Americans

Quantitative Versus Qualitative Study Comparison:
Type 2 Diabetes Among Asian Americans
Research study types tend to fall into two distinct categories—that of qualitative and quantitative research. Quantitative research studies are data-driven and seek to answer a particular research question. Qualitative research studies are open-ended and inductive in their techniques; even when they may use statistical data, their focus is experiential. When assessing the impact of a lifestyle disease like type 2 diabetes, it is particularly important to consider the lived, subjective experiences of participants, despite the protest from some quarters that qualitative research is not real science. While it might be true that the risks of developing the condition can be mitigated through weight loss and healthier eating, individuals do not always show a willingness to make lifestyle changes until it is too late. Genetic factors have a predisposition in terms of increasing the likelihood of someone developing diabetes but environment and personal decisions also have an impact. With this in mind, analyzing quantitative and qualitative studies regarding Asian-Americans’ specific predisposition to developing type 2 diabetes can be useful.
In a study by Choi (et al. 2013) using the California Health Interview Survey (CHIS) of California adults aged 18 and older (n=46,091), demographics in regards to ethnic and gender-based populations of individuals with diabetes were assessed to determine patterns of manifesting the disorder among Asian-Americans. The approach of the study was descriptive in nature. While many quantitative studies utilize the scientific method of constructing a hypothesis which can be either proved or disproved based upon the construct of the experiment, this study merely attempted to identify trends, specifically the extent to which gender and ethnicity impacted the tendency of the participants to manifest obesity. Descriptive studies are often used to support and shape later studies which have a more clearly hypothesis-driven argument.
As such, this study had no particular overriding conceptual framework. In support of its design was the notable observation that patterns of obesity often seem to be affected by genetic influences related to race, and diabetes is a disease more prevalent in the population as a whole among males rather than females. The researchers attempted to ascertain if these patterns were true of the Asian-American subset population, but stated no specific preliminary hypothesis about what they expected to find. They also did not determine beforehand if certain Asian-American populations would be more apt to manifest diabetes but rather merely examined the data and reported their findings.
The source of the data was the CHIS, a twice annual telephone survey of randomly-selected Californians of various races who are asked to answer health-related questions. To analyze the statistical data accrued by the study, a Chi-squared test was used to compare the prevalence of type 2 diabetes among different racial and ethnic categories assessed by the CHIS for both genders. Given the minimal risk to participants and the voluntary nature of the participation, the study was considered to be ethical by according to acceptable standards of research conduct.
The findings of the “age-adjusted DM and associated risk factor prevalence varies by gender and race/ethnicity among Asian subgroups as compared with Caucasian and other racial/ethnic minorities in California” given “Filipinos had the greatest likelihood of DM, followed by Koreans, and South Asians” (Choi, 2013, par. 23). There were also marked gendered differences with the subgroup of Asian-Americans: “Among men, Filipino men had the greatest DM likelihood, followed by, South Asian, and Korean men….Koreans, particularly Korean women, are newly identified high-risk group for DM and require urgent prevention effort” (Choi, 2013, par. 23).
The study was admittedly limited, given that it was conducted primarily via phone self-reports. One of the disadvantages of quantitative surveys is that there is limited ability to determine the level of candidness of participants, and using large numbers is the primary way to counteract the risk of intentionally or unintentionally misleading information. Particularly in regards to their health, people may be unwilling to be open about data that may make them uncomfortable, like unhealthy habits. Finally, the random selection of participants meant that overall the sampling was disproportionately white, resulting in a limited sampling of nonwhite participants.
In contrast, the qualitative case study by Islam (et al. 2014) examined the use of community health workers to engage in culturally specific education of a high-risk group for diabetes. The Indian subcontinent has seen one of the most notable spikes in diabetes due to the rise of affluence and this is also true of many Asian and East Asian populations within the United States. The conceptual framework of the study was that of a multicultural philosophy, stressing the fact that different groups have different health educational needs, even though diabetes may be a disease that is present cross-culturally. The framework used to educate participants was the evidence-based Diabetes Prevention Program (DPP), which has been found more effective in reducing the progression of diabetes in pre-diabetics than medications.
Requirements for participation included self-identification as a Sikh-American and overweight status. BMI criteria was used specific to Asian populations, which have traditionally manifested diabetes at lower BMIs than Caucasian populations. After initial screening, 175 individuals were selected to participate in specific New York-based communities. Six facilitated sessions with a community health worker of two hours in length on the subject of diabetes prevention such as improved nutrition and exercises were conducted face-to-face, followed by phone interviews to reinforce the message.
To assess the efficacy of the program, participants were interviewed about their perceptions of the experience. BMI and other markers of health status were also assessed. Overall, based upon patient reactions, the approach was deemed to be effective. The qualitative method allows participants to give feedback and specifically detail what aspects of the program worked for them and why they believed it worked. In contrast to a quantitative study, where only predetermined variables can be assessed, over the course of a qualitative study, the researchers’ focus can shift and change, based upon the input of the various participants.
Of course, the great disadvantage of qualitative studies is that they can be very subjective. Although the intervention seemed to be helpful, there is no way to determine that the type of program selected was the most beneficial approach, or that another approach might have been equally useful for the community. There is no way to filter out extraneous variables and there is also the fact that simply studying a population can cause changes in behavior. On the other hand, quantitative assessment techniques mean that valuable data may be overlooked, due to the relatively structured hypothesis of the researcher designed to filter out other variables or, in a descriptive study, due to the focus solely on quantitative, measurable aspects of a phenomenon.
Ultimately, using both methods is best to gain a full understanding of a complex phenomenon such as diabetes within a specific population group. Although qualitative methods may not be as rigorous as methods used in the natural sciences, when making decisions about public policy and health-related issues, researchers are assessing the effect upon human beings, not merely attempting to understand the phenomenon in the abstract. Qualitative research has a place within the field of health like all social sciences.

References
Choi, S. E., Liu, M., Palaniappan, L. P., Wang, E. J., & Wong, N. D. (2013). Gender and ethnic
differences in the prevalence of type 2 diabetes among Asian subgroups in California. Journal of Diabetes and Its Complications, 27(5), 429–435. http://doi.org/10.1016/j.jdiacomp.2013.01.002
Islam, N. S., Zanowiak, J. M., Wyatt, L. C., Kavathe, R., Singh, H., Kwon, S. C., & Trinh-
Shevrin, C. (2014). Diabetes prevention in the New York City Sikh Asian Indian
community: A pilot study. International Journal of Environmental Research and Public Health, 11(5), 5462–5486. http://doi.org/10.3390/ijerph110505462