Concordance facilitates access in diabetes care--service provider perspectives of service improvement and cultural competency

Meeting the Challenge of Diabetes in Ageing and Diverse Populations: A Review of the Literature from the UK

The impact of type 2 diabetes on ageing societies is great and populations across the globe are becoming more diverse. Complications of diabetes unequally affect particular groups in the UK older people, and people with a South Asian background are two population groups with increased risk whose numbers will grow in the future. We explored the evidence about diabetes care for older people with South Asian ethnicity to understand the contexts and mechanisms behind interventions to reduce inequalities. We used a realist approach to review the literature, mapped the main areas where relevant evidence exists, and explored the concepts and mechanisms which underpinned interventions. From this we constructed a theoretical framework for a programme of research and put forward suggestions for what our analysis might mean to providers, researchers, and policy makers. Broad themes of cultural competency; comorbidities and stratification; and access emerged as mid-level mechanisms which have individualised, culturally intelligent, and ethical care at their heart and through which inequalities can be addressed. These provide a theoretical framework for future research to advance knowledge about concordance; culturally meaningful measures of depression and cognitive impairment; and care planning in different contexts which support effective diabetes care for aging and diverse populations.

What's the worry with diabetes? Learning from the experiences of white European and South Asian people with a new diagnosis of diabetes

AIMS

An exploration of diabetes diagnosis from the patient perspective is important for understanding inequalities in access and developing quality care through the diabetes care pathway.

METHODS

South Asian and White European patients over 16 years with a recent (<1 year) diagnosis of diabetes were recruited from 18 GP practices in three UK locations--Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients, 28 South Asian and 19 White European. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups.

RESULTS

People expressed a range of emotions at diagnosis. Although many participants were familiar with diabetes through family and friends and were undergoing monitoring for comorbidities, they were surprised and upset to be diagnosed. In contrast, a small number reported how they did not worry about their diabetes diagnosis and others highlighted the different public perceptions, which exist about the seriousness of diabetes in relation to a diagnosis of cancer.

CONCLUSIONS

Attitudes to diagnosis of diabetes varied on an individual basis and not directly by ethnicity. Practitioners need to be adaptable to work with individuals in order to facilitate access and support diverse populations.

Quality improvements in diabetes care, how holistic have they been? A case-study from the United Kingdom

Aims

As quality in diabetes care includes patient centred support for self-management, investigating patients’ experiences upon diagnosis can help improve access to this element of care among diverse populations. This research explored this care in the context of recent national quality improvement initiatives which support self-management.

Methods

South Asian and White European patients over 16 years with a recent (< 1 year) diagnosis of diabetes were recruited from 18 General Practitioner (GP) practices in three UK locations - Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients.

Results

Twenty one out of 47 (45%) reported unmet support and information needs at diagnosis. Although there was a small proportion of participants (8 out of 47, 17% of all respondents) who felt they did not require any help or support with managing their diabetes because their GP had provided comprehensive and efficient care, there was an equal number who voiced a negative view of the care they had received to date. This concerned information giving, support and communication, suggesting that recently implemented national quality improvement interventions may not have been successful in improving all aspects of diabetes care, particularly those encouraging self-management. The emerging analysis led to consideration of concordance as an important concept through which to understand inequalities and improve access to quality diabetes care. In order to encourage self-management from the start, care providers need to be cognisant that patients are not homogeneous and be responsive to their different information needs and emotional responses to diagnosis.

Conclusions

In order to support self-management and deliver patient centred care in diverse populations, care providers will need to be adaptable to individual needs around diagnosis.

Nursing and health sciences workforce diversity research using PhotoVoice: a college and high school student participatory project

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities.