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Title: Delivering Diabetes Care to Ethnic Diversity (DEDICATED) : exploring potential barriers and solutions to delivering high quality diabetes care to people from ethnic minority groups
Author: Zeh, Peter
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2013
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Background/Aim Diabetes is a chronic metabolic condition with worldwide prevalence and burden increasing rapidly, particularly in ethnic minority groups (EMGs). Health inequalities and inadequate provision of diabetes care services to EMGs are recognised, primarily because EMGs express a strong cultural element in healthcare and some healthcare professionals lack sufficient cultural competence. The primary aim of this research was therefore to develop an in-depth understanding of cultural barriers within diabetes services and recommend how services can be tailored to meet the needs of EMGs with diabetes in a medium-sized UK ethnically mixed city. Methods Two systematic reviews were completed. Primary data were collected using mixed methods: a General Practice survey, participatory case study and interviews with ethnic minority patients and health workers. These were analysed using descriptive statistics and thematic comparisons. Results The findings showed cultural barriers to the uptake of diabetes services across global multi-ethnic populations and some effective interventions. The first systematic review on cultural barriers in accessing effective diabetes care services, included 22 heterogeneous studies and identified eight cultural barriers, perceived by EMGs as compromising their care. The second review elucidated approaches to overcome or minimise these barriers by investigating the impact of culturally-competent interventions from 11 experimental studies. Using a novel culturally competent assessment tool (CCAT) to assess existing interventions, it was found that any structured intervention, tailored to EMGs by integrating elements of culture, language, religion, and health literacy skills, produced a positive impact on important patient outcomes. In the Population General Practice survey, one in three people with diabetes from the diabetic population compared with one in five staff were from EMGs. Ninety-four per cent of General Practices reported the ethnicity of their populations. Improved number of diabetes annual checks was seen in the majority white British population compared to EMGs. Key cultural barriers included language and strong traditions around food, coupled with less culturally competent providers. Cultural issues were further explored in one participatory research General Practice case study. This practice selected and prioritised the designing of a Diabetes Specialist Multilingual Link Worker (DSMLW) model, aimed at bridging the inequality gaps in diabetes primary care service provision. Conclusions/recommendations This research proposes that future culturally-competent interventions should be structured, including elements of culture, language, religion and health literacy skills, tailored to the individual ethnic minority population. These components should be assessed to ensure they meet the needs of specific EMGs. In the absence of linguistically and/or culturally-competent staff, a DSMLW Service framework may support primary care. Future studies and clinical audits involving EMGs, are warranted.
Supervisor: Not available Sponsor: NHS West Midlands ; Takeda Yakuhin Kōgyō Kabushiki Kaisha ; Novo Nordisk ; Pfizer Inc.
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine