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Relationship between Ayurvedic way of life and wellness in Indo-Canadians with and without Cancer.

NET Trainee Day. Relationship between Ayurvedic way of life and wellness in Indo-Canadians with and without Cancer. Presented by – Ushasri Nannapaneni 15 th June 2007. Presentation Outline. Rationale / Background Objectives Brief Literature Review - Ayurveda Methodology

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Relationship between Ayurvedic way of life and wellness in Indo-Canadians with and without Cancer.

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  1. NET Trainee Day Relationship between Ayurvedic way of life and wellness in Indo-Canadians with and without Cancer. Presented by – Ushasri Nannapaneni 15th June 2007.

  2. Presentation Outline • Rationale / Background • Objectives • Brief Literature Review - Ayurveda • Methodology • a. Quantitative Approach • 5. Results • 6. Next Steps • a. Qualitative Approach • b. Time Line for Completion

  3. I. Background /Rationale • Since the 1960s Immigration has increased greatly to Canada, more so from the Asian sub-continent. • Indo-Canadians are the second largest Ethnic group among immigrants in Canada after the Chinese.1 • There are disparities in health and health outcomes among immigrants compared to the Canadians. We need to understand the health beliefs and various health related practices to understand how and why the “healthy immigrant effect” is lost over a period of time. Current research would help bridge the gap that exists in this learning and help cater to immigrants’ needs accordingly. II. Objectives • To examine, to what extent the Ayurvedic way of life is associated with Self Rated Health (wellness) among Indo-Canadians with cancer, compared to non-Indo-Canadians with cancer, using the CCHS 2.1 • To compare how Indo-Canadians with and without cancer rely on Ayurvedic way of life to achieve wellness, using CCHS 2.1 • To better understand the perspectives of Ayurvedic way of life in Indo-Canadian cancer patients, and its contribution to their own wellness.

  4. III. Brief Literature Review - Ayurveda • Ayurveda is whole system of healthcare that originated in India around 3000 B.C.2 • Ayurveda, is an ancient practice, and is a nature based philosophy that stresses the integration of body, mind and spirit and has its roots in the spiritual Hindu culture. 3 • ‘Ayu’ – means life or longevity and ‘Veda’ – means knowledge.4 • The underlying beliefs and principles are built on five elements of nature – Earth, Fire, Water, Air and Vacuum or Space. 5 • Ayurvedic philosophy believes that all the factors in life such as diet, exercise, weather, emotions, family dynamics, are much like the waves of the sea, which constantly are out of sync throw us out of a healthy balance. 2,6 • The balance has to be actively regained and maintained through the 7 broad areas of health of Ayurveda. 7

  5. III. Brief Literature Review – Ayurveda Contd… • Ayurvedic practitioners identify a persons’ constitution or “dosha” (psycho-physiological governing factors that have lost balance), as the basis for health and treatment along with treating the illness.6 • 3 Types of Doshas – “Pitha”, “Vatha” and “Kapha.”7 • Disease is seen as loss of dynamic balance and to not only heal disease but to re-establish balance to prevent disease from re-occurring of disease and promote positive health. • To achieve balance there are 7 broad areas in Ayurveda: 7 • 1. Diet • 2. Detoxification • 3. Physical Activity • 4. Relaxation Techniques • 5. Oral Health • 6. Rejuvenation Techniques • 7. Religion and Spirituality

  6. Conceptual Framework - Model Proposed for the study Components of Ayurvedic philosophy/ Indo-Canadian way of life Diet (Fruit and Veg. consumption) Detoxification (Food Choices) Physical Exercise (Physical activities) Relaxation Technique (Leisure activities) Rejuvenation Techniques (Dietary Supplement use) (Changes made to improve health Religion/Spirituality Oral Health (Dental visits) Length of Stay in Canada Religion Wellness (SRH) Socialization Ethnicity Culture Source: Spector RE. Cultural diversity in health and illness 1985; Oxford University Press Inc.

  7. Variables chosen from the CCHS (2.1) Survey to operationalize the Ayurvedic way of life 1. Diet (Total Fruit and Vegetable Consumption); 2. Detoxification (chooses / Avoids foods for health Reasons); 3. Physical Activity ( Freq. Physical Activity); 4. Relaxation Techniques (Sedentary Activities); 5. Oral Health (# of times one brushes teeth); 6. Rejuvenation Techniques (Dietary Supplement use); 7. Religion and Spirituality (Religion and Spirituality).

  8. IV Methodology Part 1 - Quantitative

  9. The Canadian Community Health Survey (CCHS - cycle 2.1) • CCHS – 146 Health Regions (HRs) participated in the study. • Sample – 135,573 un-weighted cases (respondents) from all the HRs answered the survey. Age – 12 and above participated. • The Survey is divided into 2 sections – a. Main Modules b. Optional Modules • Each question under these modules (sections) is treated as a variable and some of the questions from each of these sections have been selected to be the proxies for Ayurvedic way of life (ref. model for the study). • All the variables were selected based on the review of the Ayurvedic literature. • After the questions to use have been selected, some of the variables were re-coded for the purpose of analysis.

  10. Variables used for the Study • Outcome Variable – Self Rated Health (Wellness). • Independent Variables – Total Fruit and Vegetable Consumption; Chooses/Avoids foods for health reasons; Physical activity; Sedentary activities; Freq. of brushing teeth. • Demographic Variables / potential Confounders – Age; Gender, Education, Income, Marital Status; Satisfaction with life.

  11. Table 1 Main Modules in the Survey CCHS (2.1)

  12. Table 1 Optional Modules in the Survey CCHS (2.1) Contd…

  13. Table 1 Optional Modules in the Survey CCHS (2.1) Contd…

  14. Table 2 Recoded Variables

  15. Table 2 Recoded Variables Contd…

  16. Analytical Framework Demographics (Age, Gender, Marital Status) Ayurvedic way of life 1. Fruit and veg. Consumption (Representing diet in Auyrveda) 2. Food Choices (Representing Detoxification) 3. Physical Activities (Representing Physical activities) 4. Leisure Activities (Representing Relaxation Techniques) 5. Dietary Supplement Use and Changes made to improve health (Representing Rejuvenation techniques) 6. Spirituality (Representing Religion and Spirituality) 7. Dental Visits and oral health (Representing Oral Health) Length of Stay Social Support Satisfaction with life SRH (Wellness) Use of CAM SES/ Language (Income, Education) Perceived Control Over Life (mastery)

  17. V Results Part 1 Quantitative

  18. Table 1 – Demographics of the groups being compared

  19. Table 2 - Cancer cases by Ethnicity Table 3 -– Self rated health by sub-groups of interest

  20. Univariate and bivariate Analyses Objective 1 To examine, to what extent the Ayurvedic way of life is associated with Self Rated Health (wellness) among Indo-Canadians with cancer, compared to non-Indo-Canadians with cancer, using the CCHS 2.1

  21. Table 4: Ethnicity and Ayurvedic principles (Independent variables and potential confounders) * All cancer cases were selected to perform the chi square test.

  22. Table 4: Ethnicity and Ayurvedic principles (Independent variables and potential confounders) Contd…

  23. Table 4 Ethnicity and Ayurvedic principles (Independent variables and potential confounders) Contd… * All cancer cases were selected to perform the chi square test.

  24. Table 5: Self-rated health by Ayurvedic principles * All Indo-Canadian cases are selected

  25. Table 5: Self-rated health by Ayurvedic principlesContd…

  26. Table 5: Self-rated health by Ayurvedic principlesContd… *All Indo-Canadian cases are selected

  27. Final model following Logistic Regression Objective 1

  28. Table 6 Crude and Adjusted Estimates of Ayurvedic way of life of Cancer Cases on Self Rated Health Note: All Cancer cases were selected. Reference Categories- Age: 12-44; Gender: Female; Marital Status: not Single; Education <than high school; Physical Activity: Regular; Fruit and Vegetable Use: >10times; Satisfaction with life: Dissatisfied; Income: Low Income; Ethnicity: Indo-Canadians; Self Rated Health: Good

  29. Univariate and bivariate Analysis Objective 2 To compare how Indo-Canadians with and without cancer rely on Ayurvedic way of life to achieve wellness, using CCHS 2.1

  30. Table 7 Self Rated health of Indo-Canadians on Ayurvedic Principles *All Indo-Canadian Cases are selected.

  31. Table 7 Self Rated health of Indo-Canadians on Ayurvedic Principles Contd… *All Indo-Canadian Cases are selected.

  32. Table 7 Self Rated health of Indo-Canadians on Ayurvedic Principles Contd… *All Indo-Canadian Cases are selected.

  33. Table 8 Comparing Indo-Canadians with and without Cancer on using Ayurvedic way of life

  34. Table 8 Comparing Indo-Canadians with and without Cancer on using Ayurvedic way of life Contd…

  35. Table 8 Comparing Indo-Canadians with and without Cancer on using Ayurvedic way of life Contd… *All Indo-Canadian Cases are selected

  36. Final model following Logistic Regression Objective 2

  37. Table 9 Crude and Adjusted Estimates of Ayurvedic way of life on Self-rated health –Indo-Canadians Note: All Indo-Canadian Cases are selected. Reference Categories- Age: > 65; Fruit & Vegetable Use: >10 times; Gender: male; Cancer: Yes; Marital Status: Single; Physical Activity :Regular; Chooses and Avoids food: No; Satisfaction with life: Dissatisfied; Education: < than sec grad; Income: Low income; Self-Rated-health: Good

  38. Summary of findings so far Ethnicity plays a role in how one rates his/her health. Compared to Indo-Canadians, non-Indo-Canadians with cancer have 61% more chances of rating their health as poor. Conversely, Indo-Canadians with cancer have 39% less chances of rating their health as poor compared to non-Indo-Canadians with cancer. Among the Indo-Canadians, non-cancer respondents have 86% less chance of rating their health as poor. Conversely, having cancer would increase the chance of rating their health as poor by about 14%. In other words, having a chronic condition is associated with how Indo-Canadians rate their health. Age is the biggest predictor of Self-rated health for all the 3 groups being compared namely, Indo-Canadians with and without cancer, and non-Indo-Canadians with cancer. There may be an interaction between age and satisfaction with life among both the ethnic groups. This will be explored further in the qualitative enquiry.

  39. Limitations • Major limitation was the use of CCHS survey to operationalize the Ayurvedic way of life, as the survey was not designed to suit the purpose of the study. • Some of the variables chosen could not be used as there were very few respondents who answered the questions from those modules of the survey, and the variables had to be removed from the analysis. • Having no data center in Saskatchewan, the analysis took too long, and I had to rely on Statistics Canada to run the analysis on the Master files and send the results through e-mail.

  40. VI Next Steps • Methodology – Qualitative Approach • Time Line for Completion

  41. a. Methodology - Qualitative • The variables used in the Quantitative study from the CCHS Survey (Cycle2.1) will be explored in a qualitative enquiry. • 20 in-depth interviews in an ethnographic format will be conducted in Vancouver and in Saskatoon. • For the interviews purposive sampling will be used following the below mentioned criteria: • At least 60% will be females; age group will be 44-65 yrs; From middle or high income group; marital Status – married and born outside Canada. • 4. If recruitment becomes difficult, snowball technique will be used to recruit a convenience sample. • 5. Advertisement will be made in the temple asking participants to self select fro the interview. An announcement with regard to the study will also be made on the local radio. • 6. Data Analysis: Data will be analyzed using Nudist software after all the transcripts have been transcribed.

  42. Questions for the Interview • What measures do you take to promote your health? • Did you use any alternative health care measure to promote health? • Do you have any experience with using Ayurveda? • What areyour perspectives on Ayurveda? • What are your perspectives on how it helped you in achieving better health?

  43. b. Time Line for completion • Committee meeting is scheduled for the 22nd of June 2007 and an approval for the Qualitative Study will be obtained. • Discussions with Dr. Maria-Christina Barroetavena with regard to the qualitative study. • Ethics application will be submitted by the end of July to the Ethics Board at the University of Saskatchewan. • First draft of the dissertation will be written and submitted to the committee members to review by December 2007. • Results will be presented at the Departmental seminar as part of the requirement at the University of Saskatchewan.

  44. Selected References • Citizenship and Immigration Canada. Facts and Figures- Immigration Overview. Ottawa. ON, 2002. • Shanbhag V. A beginner’s introduction to Ayurvedic medicine: The science of natural healing and prevention through individual therapies. 1994; Keats Publishing Inc, New Canaan, Connecticut. • Mishra LC, Singh BB, Dagenais S. Healthcare and disease management in Ayurveda. Alt Ther Health and Med 2001; 7(2):44-51. • Robert E Svaboda. Prakriti Your Ayurvedic constitution. 1998; Lotus Press, Twin Lakes, WI. • Rhyner H. Ayurveda: The gentle Health System. 1994. New York. NY: Sterling Publishing. • Lad V. An introduction to Ayurveda. altern Iner Health Med 1995; 7(3):57-63. • Mishra LC, Singh BB, Dagenais S. Ayurveda : Historical perspective and principles of the traditional healthcare system in India. Alternative Therapies 2001; 7(2). • Spector RE. Cultural diversity in health and illness 1985; Oxford University Press Inc.

  45. Acknowledgements Funding from the Canadian Institutes for Health Research (CIHR), Palliative Care in Cross-Cultural Context – New Emerging Team (NET) for Equitable and Quality Cancer Care for Culturally Diverse Populations is gratefully acknowledged

  46. Thank You Questions?

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