A single city case survey on delivering diabetes care to ethnic minority populations

Aim: Two systematic reviews have demonstrated cultural barriers to diabetes service uptake across international multiethnic populations and effective interventions. The aim in this study was to determine the validity of these factors in one multicultural UK-city with 4.4% diabetes prevalence. Methods: A semi-structured survey comprising 35 questions was carried out in 66 General Practices (GPs) in Coventry between November 2011 and January 2012 via a population survey method. Data was analysed using descriptive statistics and thematic comparison. The survey examined the cultural competence of diabetes services using the Cultural Competence Assessment Tool (CCAT). Results: 34 practices responded (52%). Six important findings emerged: • 94% of practices numerically reported the ethnicity of their populations in broad categories. • Nine (26.47%) practices reported over 50% diabetes rates in ethnic minority groups from the general population with diabetes, the highest was 95%. • One in three people with diabetes was from an ethnic minority group, but only one in five of the healthcare staff were from an ethnic minority group • 56% of practices delivered culturally-competent diabetes services scoring 90%-100%, 26% scored 70%-89% on the CCAT. Seventeen percent delivered a lower number of culturally competent services (<70%). • Better utilisation of diabetes annual checks were reported in the general population compared to EMGs in 32 practices (94.11%). • Cultural diversity in relation to language and strong traditions around food were most commonly reported as barriers to culturally competent service delivery. Discussions/conclusions: Our study confirms the challenges found in existing literature. The CCAT measurement and improvements in baseline recording of ethnicity provide optimism for commissioning culturally-competent interventions in the city. However, further studies in similar multiethnic cities are required. If confirmed, then this has important implications for practice and, particularly, the need to develop processes for use in other cities to audit their health care provision for similar populations. Future studies should also consider the views of service-users to determine if the reported levels of culturally-competent diabetes services across most of the general practices mirror our findings and its impact on their outcomes. This study was funded by NHS West Midlands through a research fellowship