Effective management of type 2 diabetes relies on a healthy lifestyle and weight control, supplemented by medication tailored to individual requirements. It involves adapting to exercise and dietary changes that support weight loss, reduce blood sugar, and reduce the risk for arterial diseases (Finnish Institute for Health and Welfare 2025).
However, in Finland, the increasing population of Middle Eastern migrants is creating specific challenges for health care professionals as cultural traditions, beliefs, and social norms, including practices such as fasting, considerably influence lifestyle habits and management of type 2 diabetes.
Healthcare professionals must understand these factors in order to provide effective, individualized support.
Key cultural barriers to healthy lifestyle changes
Taking a close look at cultural barriers to healthy lifestyle changes is crucial. These barriers are seen in day-to-day life, influencing everything from food and hospitality customs to physical activity, religious beliefs, and family or community dynamics. Each of these factors influences how Middle Eastern immigrants experience and manage type 2 diabetes.
Two of the most significant barriers are food and hospitality. Traditional Middle Eastern dietary patterns often include three meals a day, with lunch as the main meal. Meals typically feature white rice, meat-based dishes, refined grain bread, full-fat dairy, pastries, sweetened beverages, and low-fiber and sugary food (Sami et al. 2020: 91). Traditional or socially expected forms of welcoming and hosting guests create social pressure to accept the host’s offer of delicious but fatty food or sweet tea. For a type 2 diabetic, these cultural expectations, combined with low self-efficacy, further hinder adherence to recommended dietary practices (Saber, Hassan and Ismael 2020: 43).
Another problem is that cultural and social barriers often limit regular physical activity. Cultural norms discourage exercise among women and older individuals due to perceived inappropriateness or discomfort in public places, prioritizing work over leisure, and limited physically engaging hobbies, underscoring gender-specific cultural constraints (Alfetni et al. 2022: 1). Limited regular physical activity also leads to low energy levels, which further reduces motivation to exercise. Other common challenges include lack of energy, willpower, time, skills, and fear of injury (Ahmed and Hussain 2020: 100).
Religious beliefs and festivals also shape health behaviors. Sickness is often viewed as a spiritual test linked to the belief that God controls health and illness. During Ramadan, religious values commonly take priority over health considerations. Many Muslims therefore fast, increase prayer, attend family gatherings, give to charity, and adjust mealtimes and sleep schedules. However, fasting during Ramadan poses risks for individuals with type 2 diabetes such as hypoglycemia, metabolic fluctuation, hyperglycemia, dehydration, and challenges with medication management.
Diabetic patients also often fast without consulting healthcare providers and prioritize religious observance over physical well-being (International Diabetes Federation 2021). Moreover, the Muslim religious festival of Eid, which marks the end of Ramadan and the breaking of the fast, can further disrupt healthy habits because it is traditionally celebrated with rich foods, sugary drinks, and sweets.
Finally, family and community are additional barriers to lifestyle change. Cultural traditions of hospitality, such as sharing food in large families, make it challenging for persons with type 2 diabetes to follow dietary regimens. Preparing separate meals also seems impractical and may lead individuals with diabetes to feel that they are a burden to others.
To ensure proper treatment, these concerns should be carefully evaluated during the pre-Ramadan assessment and addressed with a care plan tailored to each individual.
Practical tips for healthcare professionals to promote culturally sensitive care
Building on these cultural insights, the following practical tips aim to help healthcare professionals who care for Middle Eastern immigrants with type 2 diabetes. The suggestions below add the cultural perspective to clinical guidelines and are meant to complement rather than substitute individualized medical advice.
Communicate clearly
Develop understanding of patient’s religious beliefs for building trust and communicating effectively. Use cultural humility and shared decision-making to address challenges.
Do pre-Ramadan assessment
Review the patient’s medical history, assess the patient’s self-management skills, consider comorbidities, and discuss their previous fasting experience to identify risks and needs. Arrange a post-Ramadan appointment to review outcomes and challenges.
Educate patients
Provide culturally sensitive, Ramadan-specific education on diet, exercise, blood glucose monitoring, medication adjustment, and fasting guidelines. Explain how being active helps lower blood sugar and prevent health problems.
Create individualized management plans
Develop individualized management plans that honor cultural and religious practices while prioritizing health and safety.
Engage and encourage family
Involve the family in consultation, care plan, and education. Encourage families to maintain a healthy and balanced diet, reduce sugary foods, and participate in group walks or other light physical activities.
Offer culturally adapted advice
Recommend culturally familiar food with healthier modifications, such as using whole-grain bread, reducing sugary foods, and increasing vegetables instead of removing traditional dishes. Consider providing women-only exercise sessions or family-friendly classes and recommend home-based exercise routines.
Provide community and peer support
Promote awareness of the importance of pre-Ramadan consultation by organizing community workshops that involve family and religious leaders. Collaborate with religious leaders to make physical activity a regular part of community events and religious gatherings.
By offering this kind of culturally adapted advice and community support, healthcare professionals can help patients fast safely while maintaining their health and well-being.
A vital message for multicultural diabetes care
Promoting health among culturally diverse groups requires more than standard clinical guidelines. Culturally sensitive, personalized, and community-based approaches are essential. Understanding the cultural context and traditions enables healthcare providers to design effective interventions and help patients adapt to sustainable lifestyle modifications, which respect their religious beliefs and traditions. For an individual with type 2 diabetes, this can be lifesaving.
References
Alfetni, A., Alqahtani, M., Alhumaid, A., Alhazmi, A., Alqahtani, B., Alghamdi, K., Alsaedi,Z., Alsulaimani, W., Alqurashi, R., Binhumaid, A. and Alfattani, 2022. Physical Activityprevalence and Barriers among type 2 diabetic patients, Kudai and Al-hijra primaryhealth care center, Makkah, Saudi Arabia. Medical science 26 (126). 1-10.
Ahmed, R.A. and Hussain, RN., 2020. Physical activity and perceived barriers amongtype 2 diabetic patients in Erbil City. Erbil Journal of Nursing and midwifery 3 (2). 100-107.
Finnish Institute for Welfare and Health 2025. How is type 2 diabetes managed.Updated 30 May 2025. https://www.terveyskyla.fi/en/diabeteshub/diabetes/type-2-diabetes/how-is-type-2-diabetes-managed. Accessed 5 November 2025.
International Diabetes Federation 2021. Diabetes and Ramadan Practical Guidelines. https://www.diabetes.org.sg/wp-content/uploads/2021/11/IDF-Diabetes-and-Ramadan-Practical-Guideline-2021.pdf. Accessed 21 November 2025.
Saber, S.S., Hassan, M.T. and Ismael, S.A., 2020. Dietary habits among type 2 diabeticpatients in Erbil City. Journal of Kurdistan Board of Medical Specialties 6 (1). 43-49.
Sami,W., Alabdulwahahab, K.M., Ab Hamid, M.R., Alasbali, T.A., Alwadabi, F.A. andAhmed, M.S., 2020. Dietary attitude of adults with type 2 diabetes mellitus in theKingdom of Saudi Arabia: A cross- sectional study. Medicina 56 (2). 1-9.
Authors
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Rezhna Ahmed
Master’s Student, Metropolia UAS, School of Health Care, Registered NurseAbout the author -
Jukka Kesänen
Principal Lecturer, Metropolia UAS, School of Health CareJukka Kesänen is the Head of the Master’s Degree Programme in Development and Leadership of Nursing. His research areas include patient education and higher education.
About the author