5th Annual Mixed Methods Conference 8th to 11th July 2009, What are the Barriers and Facilitators to Diabetes self-management in Ethnic Minority communities?

What are the Barriers and Facilitators to Diabetes self-management in Ethnic Minority communities? A mixed methods review. Abstract: Type 2 diabetes (D2) is more prevalent in some ethnic minority populations. Moreover many minority groups have poor health literacy – the skills needed to access, understand and use information to promote and maintain health, including self management. Self-management is the cornerstone of effective diabetes care. This systematic review’s aims were to (1) explore patients “views” on barriers and facilitators to effective D2 self management; (2) identify the effectiveness of D2 self management interventions and (3) assess how well interventions match recommendations derived from “views”.
Rabiya Majeed presented some of the findings of the first stage of her research. She explained that Type 2 diabetes has reached epidemic proportions and that although diabetes is a self manageable illness, migrant populations are less equip to do so due to their being typically of lower socio-economic groups.

Rabiya posed the questions:

1. What are ethnic minority patients’ views concerning the self management of D2?
2. How effective and appropriate are existing interventions to support self management of D2 in ethnic minority patients?
3. Do existing interventions address the identified views of ethnic minority patients withD2

Rabiya recognised that a traditional Cochrane style review alone would not provide complete answers and elected to follow guidelines by the EPPI-centre which produce a more flexible framework resulting in answers to multiple questions of numerous study designs.

Rabiya divided her review into two strands, one focusing on intervention studies to address question 2, one focusing on views studies to address question 1 and by synthesising the two Rabiya expected to be able to answer question 3.

A massive 15,725 studies were initially identified. Through filtering these through title screening, abstract screening and then specific relevance criterion Rabiya had 57 views studies and 29 intervention studies included.

Review was complex for a number of reasons, not least the heterogeneity of trials. Meta analysis was therefore not appropriate but Rabiya was able to present her findings in table form beautifully illustrating where there were significant findings.

Time restrictions allowed Rabiya to present just a few conclusions. Multi-component interventions are more effective than single component interventions, culturally competent interventions (ie where risk factors such as poverty are targeted) are more likely to be effective than those that were not, interventions delivered with BOTH a group and individual component are more effective than just one format alone and no intervention lasting less than one month was effective.

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