Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.

Research activity in this field has increased considerably over the past 6 years, with culturally appropriate diabetes education showing consistent benefits over conventional care in terms of glycaemic control and diabetes knowledge, sustained in the short- to mid-term. Further research is needed to determine the clinical significance of these improvements and their cost-effectiveness.

The Hippokrates Exchange programme (HEP) is designed to give early career General Practitioners (Associates in Training (AITs)/First5s) first-hand experience into concepts of a primary healthcare system outside of their host country. The aim is to improve GP knowledge and skills, inspire professional development and promote a global approach to primary care. Although an increasing number are taking up this opportunity, their views and experiences of international exchanges are not well described. The aim of the study was to explore the experiences of AITs/First5s following their HEP exchanges. This qualitative study analysed 16 post-exchange reports of UK participants visiting 10 European countries via the HEP, using a thematic approach. Participants were unanimously positive about their exchange experiences. The themes that emerged were (1) Comparison of primary care practice (2) Infrastructure of host primary care (3) Motivation and experience of exchanges and (4) Learning and reflection. Participants displayed considerable benefits from these exchanges by broadening their experience in different primary care systems and identifying improvements to be incorporated into their UK practice.

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