An Examination of Health Behaviors among Ethiopian-Israeli Adults with Regard to Type 2 Diabetes

Type II Diabetes Mellitus (DM-2) is a metabolic disease characterized by a high concentration of blood sugar. DM-2 develops mostly in adults. It is one of the most common non-communicable diseases worldwide, causing significant morbidity. Risk factors for development of DM-2 can be divided into genetic factors that are partially understood and environmental factors, which are well-described and significantly related to lifestyles, lack of physical activity and unhealthy nutrition, with the risk of developing diabetes among certain ethnic groups, such as Ethiopian immigrants in Israel. For Ethiopian immigrants in Israel, immigration to Israel was an abrupt transition from the traditional way of life to the western one. Although DM-2 was a rare occurrence back in Ethiopia, during the post-immigration years Ethiopian immigrants in Israel have been developing DM-2 at a higher rate compared to the Israeli-born population. Studies show that the most effective primary prevention of DM-2 is through healthy behavior, which includes performing physical activity and consuming healthy nutrition. Despite the importance of healthy behavior, this issue has hardly been explored among the Ethiopian population in Israel.

Therefore, the purpose of the current study was to expand the existing body of knowledge and to investigate healthy behavior (physical activity and consuming healthy nutrition) among the Ethiopian immigrants in Israel by comparing them to the Israeli-born population. The Theory of Planned Behavior (Ajzen, 1988), which incorporates personal social and cognitive variables, served as the theoretical base for the study.

This is a comparative quantitative study. Dependent variables included actual health behavior (physical activity, consuming healthy nutrition). Independent variables, according to the theory, included attitudes, subjective norms (perception of social support), perceived control and the intention for health behavior. In this study, the model was expanded by using two additional independent variables that were found related to health behavior: perceived susceptibility, which stands for the person’s perception of the risk to develop DM-2, and perceived health status, which stands for the person’s subjective view of his health condition. In addition, we accounted for the socio-demographic variables.

The study sample included 207 adults ages 30 and older who did not have diabetes, including 110 Ethiopian immigrants in Israel and 97 Israeli-born population. Subjects were recruited through community contacts, snowball sampling and social media groups of the Ethiopian immigrants. All data was collected at a single timepoint.

The results of the study show that among the whole sample most participants reported low perceived susceptibility to of DM-2. In other words, they did not consider themselves being at risk of developing DM-2. Those who did consider themselves at risk of DM-2 were less likely to be physically active and consume healthy nutrition. In the field of physical activity, 61% of the participants reported being physically active and 39% reported not being physically active. There were no significant differences between Ethiopian immigrants and Israeli-born population with respect to physical activity. However, the rate of those who reported participating in a "class / gym" type of exercise was significantly higher among Israeli-born population compared to Ethiopian immigrants. In the field of ​​comsuming healthy nutrition, unealthy nutrition was reported significantly more often by Ethiopian immigrants, compared to the Israeli-born population, 33.6% vs 21.6%, respectively. Logistic regression analysis for the whole sample showed the following significant predictors of physical activity: marital status as single, perceived susceptibility to DM-2 (negative predictor), perceived health status, attitudes, subjective norms and intention to do physical activity. The proportion of explained variance was 47.2%. A logistic regression test for healthy nutrition consumption throughout the sample showed the following significant predictors of healthy nutrition: marital status as married, high education, perceived susceptibility to DM-2 (negative predictor), perceived control and intention to consume healthy nutrition. The proportion of explained variance was 42.7%.

As a conclusion, the results show that behavior patterns among Ethiopian immigrants in Israel are essentially similar to those of Israeli-born population. According to literature, it is a common phenomenon that populations who immigrant to western countries often adopt the less healthy behavior of the local population and thus lose the health benefit they came with.

The contribution of this study is both in the theoretical and practical levels. Theoretically, it has expanded the knowledge and understanding of health behavior, physical activity and consuming health nutrition, with respect to DM-2, among the Ethiopian immigrants in Israel. It has described factors that predict health behavior and the differences between Ethiopian immigrants in Israel and Israeli-born population in health behavior. This study results comply with the Theory of Planned Behavior. Practically, the importance of the study is in emphasizing the need for intervention programs to increase regular physical activity and increase healthy eating, in order to promote the health status of Ethiopians immigrants in Israel and prevent the onset of DM-2 among them. Study results show that this could be accomplished by strengthening personal cognitive and social resources, that are necessary for success in adopting health behavior