The provision of culturally-competent diversity interventions to ethnic minority groups with diabetes: A systematic review

Aim: Examine the effectiveness of culturally-competent interventions and innovations tailored to the needs of ethnic minority groups (EMGs) with diabetes globally

Methods: We searched four databases (Medline (NHS Evidence), CINAHL, Cochrane, DARE) and reference lists of retrieved papers from inception to April 2010, including two NHS specialist libraries for diabetes, and ethnicity and health. Furthermore, three topic experts were contacted. Two reviewers independently conducted paper selection and appraisal.

The criteria for inclusion in the analysis were all effectiveness studies of any specified diabetes health-related intervention to any EMG within a majority population with diabetes. Data were collected on all reported outcome measures.

Results: Ten out of 277 studies were included. The heterogeneity of the studies required narrative analysis. Participants were recruited from 3 settings (primary care, hospital or community) and varied greatly such as South Asians, Russians, Hispanics, Turkish, etc. Study designs were varied and involved delivery by varied health workers, e.g. certified diabetes educators, registered dieticians, podiatrist, bilingual health advocates, etc. Various outcomes were reported which included 7 self reported outcomes (e.g. satisfaction with diabetes education programmes), 9 assessed by staff (eye checks) and 4 objective validation (HbA1C). No study formally set out to systematically assess the quality of life or the cost effectiveness of their interventions. Despite methodological limitations within the studies, findings suggest that interventions that were tailored to EMGs by integrating the element of culture into that intervention, (cultural and religious beliefs including linguistic and literacy skills), produced a positive effect. This was consistent in most of the studies.

Discussion/conclusion: We identified benefits in using culturally-competent interventions with EMGs with diabetes. Due to the mixed methodologies and outcome measures in the review, the data did not allow for convincing comparisons across countries, EMGs, or the type of interventions. Therefore, further culturally-competent interventions are required and should include the cost-effectiveness evaluation which can easily influence diabetes service commissioners to decide on its implementation. Furthermore, culturally-competent structured education programmes are required and should include community leaders/companions of specific EMGs.