Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials

Healthcare, self-care, and health status of immigrants and non-immigrants with type 2 diabetes in the Canadian Community Health Surveys

AIMS

To identify healthcare, self-care, and health status disparities between immigrants and non-immigrants with type 2 diabetes mellitus (T2DM) in Canada.

METHODS

Immigrants and non-immigrants with T2DM were compared in the nationally representative 2005 and 2007 Canadian Community Health Surveys (N = 7658 representing 1,205,000 in 2005; N = 3605 representing 1,446,000 in 2007).

RESULTS

No significant differences existed between immigrants and non-immigrants with T2DM in annual glycated hemoglobin testing, foot examination by a physician, urine protein testing, or eye examinations. Among self-care measures, immigrants were less likely to perform foot self-examination at least weekly (OR = 0.70 [0.50, 0.98] in 2005; OR = 0.65 [0.47, 0.91] in 2007) or smoke (OR = 0.63 [0.45, 0.87] in 2005; OR = 0.44 [0.25, 0.77] in 2007), but there were no differences in self-monitoring of blood glucose or physical inactivity. With respect to health status, immigrants were less likely to have a chronic condition in addition to T2DM (OR = 0.68 [0.54, 0.86] in 2005; OR = 0.59 [0.41, 0.84] in 2007), but there were no differences in self-perceived general or mental health.

CONCLUSIONS

Healthcare, self-care, and health status were similar in immigrants and non-immigrants with T2DM in Canada; however, immigrants were less likely to regularly examine their feet. Culturally appropriate footcare education should be considered to prevent lower limb complications.

The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review

AIM

To examine the evidence on culturally competent interventions tailored to the needs of people with diabetes from ethnic minority groups.

METHODS

MEDLINE (NHS Evidence), CINAHL and reference lists of retrieved papers were searched from inception to September 2011; two National Health Service specialist libraries were also searched. Google, Cochrane and DARE databases were interrogated and experts consulted. Studies were included if they reported primary research on the impact of culturally competent interventions on outcome measures of any ethnic minority group with diabetes. Paper selection and appraisal were conducted independently by two reviewers. The heterogeneity of the studies required narrative analysis. A novel culturally competent assessment tool was used to systematically assess the cultural competency of each intervention.

RESULTS

Three hundred and twenty papers were retrieved and 11 included. Study designs varied with a diverse range of service providers. Of the interventions, 64% were found to be highly culturally competent (scoring 90-100%) and 36% moderately culturally competent (70-89%). Data were collected from 2616 participants on 22 patient-reported outcome measures. A consistent finding from 10 of the studies was that any structured intervention, tailored to ethnic minority groups by integrating elements of culture, language, religion and health literacy skills, produced a positive impact on a range of patient-important outcomes.

CONCLUSIONS

Benefits in using culturally competent interventions with ethnic minority groups with diabetes were identified. The majority of interventions described as culturally competent were confirmed as so, when assessed using the culturally competent assessment tool. Further good quality research is required to determine effectiveness and cost-effectiveness of culturally competent interventions to influence diabetes service commissioners.

Public knowledge of diabetes in Karen Ethnic rural residents: a community-based questionnaires study in the far north-west of Thailand

Background and purpose

The public knowledge of diabetes is important for prevention of disease. This study aimed to evaluate knowledge of diabetes, risk factors, and the common warning signs of diabetes and complications among community participants in a rural Karen ethnic community.

Methods

Participants were asked to answer a questionnaire regarding their knowledge of diabetes. Fasting blood glucose testing, blood pressure measurement, and body mass index (BMI) assessment were provided to the participants. The study was conducted at Thasongyang district, Tak province, Thailand.

Results

A total of 299 Karen rural residents were included in the study. The median age was 45 years and median fasting blood glucose was 88 mg/dL. The response rate to the questionnaires was 91.97%. Half of the participants knew diabetes is a noncommunicable disease needing lifelong treatment. Overall, one-third of the community participants could correctly answer the knowledge assessment questions regarding risk factors and common features of diabetes. whereas the other two-thirds either gave a wrong answer or were “not sure”. Female participants had poorer diabetes knowledge than the males.

Conclusion

The public knowledge of diabetes, as represented by this sample of the Karen ethic community, is alarmingly low. There is significant gender difference in knowledge level. Culturally tailored and gender-sensitive diabetes health education interventions are urgently needed in this minority ethnic community.

Afrocentric cultural values and beliefs: movement beyond the race and ethnicity proxy to understand views of diabetes

PURPOSE

The purpose of this study was to estimate the benefit of using a cultural characteristics scale to help diabetes educators understand how African Americans cope with diabetes. Illness representations are influenced by culture. Race and ethnicity as a proxy for culture provides an incomplete understanding of the mechanism by which cultural values influence representations of diabetes.

METHODS

A descriptive correlational design was employed by recruiting hospitalized adults with type 2 diabetes at 3 metropolitan northeast coast sites. The TRIOS Afrocentric cultural characteristics measure and the Illness perception Questionnaire were administered by paper-and-pencil to a diverse sample. Black race and African American ethnicity was used as a proxy for culture and compared to levels of agreement on an Afrocentric cultural scale to determine the relative ability to explain variance in illness representations of diabetes.

CONCLUSION

The TRIOS measure adapted to diabetes care explained variance in illness representations of diabetes, while African American ethnicity/black race was not able to explain variance in illness representations. Clinicians would benefit from considering the degree to which a patient identifies with particular cultural characteristics when tailoring interventions to manipulate illness representations that are not concordant with biomedical representations.

Evaluating a Culturally Competent Health Coach Intervention for Chinese American Patients with Diabetes

Abstract

Background. Type 2 diabetes is a growing concern among medically underserved Chinese Americans. However, very few interventions have been developed or adapted for Chinese Americans with diabetes.

Objective. To use a participatory research approach to evaluate the effectiveness of a culturally tailored, linguistically appropriate model for diabetes care employing health coaches to improve A1C levels among Chinese-American patients in a federally qualified health center setting.

Methods. We compared change in A1C between intervention participants (n = 46), who received a health coaching intervention, and control participants (n = 46), who received usual care over a period of ~ 6 months.

Results. Intervention participants showed a decrease in mean A1C at follow-up (−0.40%) compared to control subjects (+0.04%), although this difference was not statistically significant. At the 6-month follow-up, a significantly higher percentage of intervention participants (45.7%) had well-controlled A1C levels compared to control subjects (23.9%) (P = 0.048).

Conclusions. It is feasible to implement a culturally tailored, linguistically appropriate teamlet model of care for Chinese Americans with type 2 diabetes. Such a model may be helpful in reducing A1C levels. Given trends in A1C improvement during a 6-month pilot, future randomized trials with a larger sample capable of providing adequate statistical power to detect improvements are warranted.

Development and Implementation of a Culturally Tailored Diabetes Intervention in Primary Care

Diabetes education for ethnic minorities should address variations in values underlying motivations, preferences, and behaviors of individuals within an ethnic group. This paper describes the development and implementation of a culturally tailored diabetes intervention for Puerto Rican Americans that can be delivered by a health care paraprofessional and implemented in routine clinical care. We describe a formative process, including interviews with providers, focus groups with patients and a series of multidisciplinary collaborative workshops used to inform intervention content. We highlight the intervention components and link them to a well-validated health behavior change model. Finally, we present support for the intervention's clinical effects, feasibility, and acceptability and conclude with implications and recommendations for practice. Lessons learned from this process should guide future educational efforts in routine clinical care.

Web-based interventions for the management of type 2 diabetes mellitus: a systematic review of recent evidence

INTRODUCTION

The Internet has emerged as a potentially effective medium for information exchange. The Internet's potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases such as diabetes mellitus. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus.

METHOD

Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PsycINFO, Web of Science and Cochrane Library to retrieve articles published between 2000 and June 2010 which fulfilled all inclusion criteria. Methodological quality assessment and data synthesis were then performed.

RESULTS

Twenty articles representing 13 different studies were reviewed. None of the studies were ranked as low in the methodological quality. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well.

CONCLUSION

The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.

Nutrition in an ethnically diverse society: what are some of the key challenges?

The role of nutrition is especially important in certain ‘lifestyle’ diseases that impact disproportionately on ethnic minority populations. The aim of this paper is to review the evidence of risk, health outcomes and interventions for certain diseases that affect the UK's largest ethnic minority group (South Asians) in order to help professionals better address the needs of this diverse population. Research evidence is presented on factors influencing access to services by ethnic minority populations and the changing UK policy background for public health and preventive care. The available research base on obesity, diabetes and CVD is discussed. Conditions such as type 2 diabetes, which are more prevalent among the South Asian population, are associated with poorer health outcomes and appear to exhibit links to diet and nutrition that start in childhood or even before birth; all making preventive care important. Obesity is a major risk factor and it appears that BMI thresholds may need to be lower for South Asians. Targeted interventions to improve diet and outcomes in the South Asian population also appear promising. Recent moves to promote access to evidence of ethnicity and health and to improve the cultural competence of organisations are discussed. Health professionals will increasingly need to promote lifestyle changes in a manner that meets the needs of a diverse population in order to address future public health challenges. Nutritionists and other professionals will need to ensure that interventions are culturally appropriate and involve engagement with extended family members and communities.