Objective To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community. Design Qualitative study (focus groups and semistructured interviews). Setting Tower Hamlets, a socioeconomically deprived London borough, United Kingdom. Participants Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3). Methods 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis. Results Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding.

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The objective of this study was to assess and compare the self-perceived work-related stress of emergency department (ED) and general ward (GW) nurses and to assess the relationship between self-perceived stress and salivary cortisol levels in these groups of nurses. Seventy-three female ED (n = 23) and GW (n = 50) nurses from a general hospital completed a self-administered questionnaire. A modified mental health professional stress scale (PSS) was used to measure self-perceived work-related stress. Salivary samples were collected at the start and end of morning shiftwork. An enzyme-linked immunosorbent assay method was used to determine the salivary cortisol concentration (nmol/L). ED nurses perceived that nursing was more stressful (mean, 1.58; 95% confidence interval [CI], 1.35 to 1.81) than did GW nurses (mean, 1.30; 95% CI, 1.18 to 1.40). On the PSS subscales, scores of organizational structure and process, lack of resources, and conflict with other professionals were higher in ED nurses (all P < 0.01). The morning cortisol was significantly lower in ED (geometric mean, 9.10; 95% CI, 6.62 to 12.42 nmol/L) than in GW (geometric mean, 15.45; 95% CI, 11.86 to 20.14 nmol/L) nurses. Log morning salivary cortisol was negatively correlated with PSS (r = -0.255), scores of organizational structure and process, and conflict with other professionals (all P < 0.05). The difference between morning and afternoon cortisol concentration in ED nurses (geometric mean, 6.35; 95% CI 4.14 to 9.93 nmol/L) was lower than in GW nurses (geometric mean, 12.42; 95% CI, 9.38 to 16.28 nmol/L). The log value of the difference correlated marginally with PSS (r = -0.21, P = 0.07) and significantly with scores of organizational structure and process, lack of resources, and conflict with other professionals (all P < 0.05). There was no difference between the two groups in afternoon salivary cortisol level. ED nurses perceived more stress compared with GW nurses. Morning salivary cortisol concentration is better correlated with PSS compared with the morning-afternoon salivary cortisol difference. The result raises the possibility of using a single morning salivary cortisol sample to reflect self-perceived stress.