Cultural Influences, Experiences and Interventions Targeting Self-Management Behaviours for Prediabetes or Type 2 Diabetes in First-Generation Immigrants: A Scoping Review

AIM

To map the existing evidence and identify research gaps regarding the self-management of prediabetes or type 2 diabetes among first-generation immigrants ≥ 18 years.

DESIGN

A scoping review followed the JBI guidelines and was in accordance with the PRISMA extension for Scoping Reviews.

METHODS

A systematic search of CINAHL, Cochrane, EMBASE, MEDLINE, PsycINFO, ProQuest, SCOPUS and the Web of Science was conducted. Grey literature and reference lists of included studies were searched for additional citations. Articles published in English from the database inception to February 2023 were included.

RESULTS

We included 96 studies, of which 28.1% were published within the last 5 years. Most studies (71.9%) were conducted in the United States. Study participants were recruited mainly from community settings and English was their second language. The most common study methodologies used were cross-sectional surveys and phenomenological interviews. Only two studies specifically focussed on individuals with prediabetes. Multiple factors, such as age, gender, country of origin and other societal, linguistic, cultural and resource barriers or facilitators, as well as patient's cultural unique experiences, were of particular significance for self-management behaviours. Although several studies reported that culturally tailored interventions were feasible and acceptable among first-generation immigrants living with type 2 diabetes but not prediabetes, the duration and intensity of these interventions varied.

CONCLUSION

Health professionals should consider various demographic, societal, linguistic and cultural factors, such as participants' low English language proficiency, and provide appropriate support for this group to ensure better self-management behaviours. Tailoring interventions to individual and cultural preferences in collaboration with key stakeholders is crucial for adult immigrants with prediabetes and type 2 diabetes across diverse cultural and ethnic groups.

IMPACT

Developing and applying culturally tailored self-management interventions for the targeted population, particularly those with prediabetes, should be an important direction for future research. No Patient or Public Contribution.

The Effect of Nursing Approach on the Self-Management and Adjustment to the Illness among Newly Diagnosed Diabetic Patients According to Meleis's Transition Theory

This study aimed to determine how the nursing approach based on Meleis's transition theory affects the self-management and adjustment to the illness among newly diagnosed diabetic patients. The study was conducted as one-group and pretest-posttest quasi-experimental design. The data were collected using the Introductory Questionnaire, the Diabetes Self-Management Questionnaire (DSMQ), and the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR). It was determined that there was a positive increase in the total score of the DSMQ after the intervention, and a positive decrease in the total score of the PAIS-SR, and the difference between the scores were statistically significant (p < .05).

Fear of Cancer and State Anxiety Among Women Undergoing Hysterectomy: A Cross-sectional Study

BACKGROUND

Fear of cancer may develop after surgery in women who underwent surgery for suspected malignancy in preoperative examinations. It is important from a psychosocial point of view that the fear of cancer and the factors affecting anxiety are determined and necessary interventions are made.

OBJECTIVES

The aim of this study was to determine the level of state anxiety, fear of cancer, and influencing factors in women who had hysterectomies with a risk of cancer in the waiting period for the pathology result.

METHODS

The research data were collected from 109 women who underwent hysterectomy while waiting for the pathology result on the third or fourth postoperative day. Patients completed the Personal Information Form, State-Trait Anxiety Inventory-I, and Cancer Worry Scale.

RESULTS

Women who underwent hysterectomy with the risk of gynecological cancer had high levels of state anxiety and cancer fear after hysterectomy; type of hysterectomy significantly affected cancer fear (P = .022), and social support (P = .015), type of hysterectomy (P = .024), and family history of cancer (P = .022) significantly affected state anxiety.

CONCLUSION

The management of these women's concerns can be improved if healthcare professionals know more about the factors affecting their state anxiety and fear.

IMPLICATIONS FOR PRACTICE

Health professionals witness patients' most private experiences and play a key role in providing care and support. This study may be foundational in the planning and implementation of nursing interventions to manage causes of anxiety and fear during this waiting period.

Pathway From Type 2 Diabetes Diagnosis to Action: How to Move People Forward

Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: 1) type 2 diabetes diagnosis competes with other complex life challenges, 2) difficulty in performing behavior modification actions, 3) lack of support, 4) emergence of emotional and psychological issues, and 5) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition.

How chronic conditions are understood, experienced and managed within African communities in Europe, North America and Australia: A synthesis of qualitative studies

This review focuses on the lived experiences of chronic conditions among African communities in the Global North, focusing on established immigrant communities as well as recent immigrant, refugee, and asylum-seeking communities. We conducted a systematic and narrative synthesis of qualitative studies published from inception to 2022, following a search from nine databases-MEDLINE, EMBASE, PsycINFO, Web of Science, Social Science Citation Index, Academic Search Complete, CINAHL, SCOPUS and AMED. 39 articles reporting 32 qualitative studies were included in the synthesis. The studies were conducted in 10 countries (Australia, Canada, Denmark, France, Netherlands, Norway, Sweden, Switzerland, United Kingdom, and the United States) and focused on 748 participants from 27 African countries living with eight conditions: type 2 diabetes, hypertension, prostate cancer, sickle cell disease, chronic hepatitis, chronic pain, musculoskeletal orders and mental health conditions. The majority of participants believed chronic conditions to be lifelong, requiring complex interventions. Chronic illness impacted several domains of everyday life-physical, sexual, psycho-emotional, social, and economic. Participants managed their illness using biomedical management, traditional medical treatment and faith-based coping, in isolation or combination. In a number of studies, participants took 'therapeutic journeys'-which involved navigating illness action at home and abroad, with the support of transnational therapy networks. Multi-level barriers to healthcare were reported across the majority of studies: these included individual (changing food habits), social (stigma) and structural (healthcare disparities). We outline methodological and interpretive limitations, such as limited engagement with multi-ethnic and intergenerational differences. However, the studies provide an important insights on a much-ignored area that intersects healthcare for African communities in the Global North and medical pluralism on the continent; they also raise important conceptual, methodological and policy challenges for national health programmes on healthcare disparities.

Self-Care of African Immigrant Adults with Chronic Illness

This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.

Maintaining cultural identity: A systematic mixed studies review of cultural influences on the self-care of African immigrants living with non-communicable disease

AIM

To understand and identify cultural factors influencing the self-care practices of African immigrants living with chronic illness in countries outside Africa.

BACKGROUND

The influence of cultural factors on self-care is relatively unexplored in African immigrants with non-communicable diseases (NCDs).

DESIGN

Systematic Mixed Studies review.

DATA SOURCES

PubMed, Psych Info, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus and Sociological Abstract computerized databases. No limit was placed on publication date.

REVIEW METHODS

Results-based convergent design was used. The Mixed Method Appraisal Tool was used to evaluate the studies. Quantitative studies were synthesized narratively while qualitative studies were synthesized using thematic synthesis.

RESULTS

We identified 251 articles and nine fulfilled our inclusion criteria. The studies were published between 2006 and 2019, with six qualitative and three quantitative studies. Studies were conducted in the United States, Australia, Sweden, the Netherlands and the United Kingdom. Most studies examined the influence of culture on self-care of diabetes (n = 6), while the rest focused on hypertension (n = 3). Findings highlight that cultural norms and practices, non-Western approaches to interpreting and managing illness, cultural connotations of health behaviours and structural challenges influencing self-care. Cultural food preferences made adherence to prescribed diets challenging. Family support facilitated self-care. Maintaining cultural identity was both a driver and constraint to engaging in self-care.

CONCLUSION

The complex interplay of cultural and structural factors influences the willingness of Africans who have immigrated to a developed country to follow recommended self-care practices. Considering these cultural norms and structural barriers can help to explain the self-care behaviours of African immigrant populations.

IMPACT

Clinicians and policymakers who account for structural factors and integrate cultural factors into care facilities, treatment protocols and policy can be influential in promoting self-care in African immigrant populations.

Prevalence and Associated Risk Factors of Diabetes in the African Immigrant Population of Sacramento County, California

Purpose

The purpose of this study was to determine the prevalence and associated risk factors of diabetes in the African immigrant population in Sacramento County, California.

Methods

A cross-sectional study was conducted in Sacramento County, California, from June to August 2018. The convenience sample included 126 African immigrants aged 21 years and older. Sociodemographic and clinical characteristics were collected. Hemoglobin A1C (A1C) level, blood pressure, height, and weight were measured per standard methods. Data were analyzed using descriptive statistics and χ2 test at value of P < .05.

Results

Of 126 adult individuals included in this study, 32 (25.4%) had diabetes, of whom 25 (19.8%) were previously diagnosed and 7 (5.6%) represented new cases of diabetes. Also, 36 (28.6%) had prediabetes, of whom 24 (19.1%) had previously been told they had prediabetes and 12 (9.5%) represented new cases of prediabetes. Diabetes and prediabetes were significantly higher among participants in the age group of 36 to 60 years, married, employed full-time, and those with hypertension, high blood cholesterol, and participating in 0 to 2 days per week of moderate physical activities. Only one-fifth of all participants with previously known diabetes or previously on treatment had a good glycemic control status.

Conclusions

The present study found a high prevalence of prediabetes, diabetes, and multiple risk factors of diabetes in the African immigrant population, as well as a poor glycemic control among those with diabetes, calling for urgent attention. Strategies aimed to improving a healthy lifestyle in the African immigrant population are necessary to reduce the burden of diabetes.