Barriers and Facilitators for Type-2 Diabetes Management in South Asians: A Systematic Review

Abstract

ObjectiveAlthough South Asian populations have among the highest burden of type 2 diabetes in the world, their diabetes management remains poor. We systematically reviewed studies on South Asian patient’s perspectives on the barriers and facilitators to diabetes management.MethodsWe conducted a literature search using OVID, CINHAL and EMBASE (January, 1990 –February, 2014) evaluating the core components of diabetes management: interactions with health care providers, diet, exercise, and medication adherence. South Asian patients were self-reported as Indian, Pakistani, Malaysian-Indian or Bangladeshi origin. From 208 abstracts reviewed, 20 studies were included (19 qualitative including mixed methods studies, 1 questionnaire). Barriers and facilitators were extracted and combined using qualitative synthesis.ResultsAll studies included barriers and few facilitators were identified. Language and communication discordance with the healthcare provider was a significant barrier to receiving and understanding diabetes education. There was inconsistent willingness to partake in self-management with preference for following their physician’s guidance. Barriers to adopting a diabetic diet were lack of specific details on South Asian tailored diabetic diet; social responsibilities to continue with a traditional diet, and misconceptions on the components of the diabetic diet. For exercise, South Asian patients were concerned with lack of gender specific exercise facilities and fear of injury or worsening health with exercise. Patients reported a lack of understanding about diabetes medication management, preference for folk and phytotherapy, and concerns about the long-term safety of diabetes medications. Facilitators included trust in care providers, use of culturally appropriate exercise and dietary advice and increasing family involvement. Overall themes for the barriers included lack of knowledge and misperceptions as well as lack of cultural adaptation to diabetes management.ConclusionDiabetes programs that focus on improving communication, addressing prevailing misconceptions, and culture specific strategies may be useful for improving diabetes management for South Asians.

Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: an integrative review

“…Celebrating with family or friends is a problem because patients often do not want to tell people in their environment about their health problems; other problems include being alone and not having support, which can lead to depression and a lack of motivation (Ahrani et al., ; Mellon et al., ). Similar results were also obtained in a systematic review on barriers and facilitators for the management of type 2 diabetes, which identified social pressure at social events, together with circumstances that can lead people to prepare traditional cuisine dishes and associated cultural issues (Sohal, Sohal, King‐Shier, & Khan, ). Simultaneously, family support can be a facilitating factor when meals are prepared at home (Ahrani et al., ; Mellon et al., ; Oh et al., ; Sohal et al., ).…”

“…Similar results were also obtained in a systematic review on barriers and facilitators for the management of type 2 diabetes, which identified social pressure at social events, together with circumstances that can lead people to prepare traditional cuisine dishes and associated cultural issues (Sohal, Sohal, King‐Shier, & Khan, ). Simultaneously, family support can be a facilitating factor when meals are prepared at home (Ahrani et al., ; Mellon et al., ; Oh et al., ; Sohal et al., ).…”

“…Similarly, Sohal et al. () reported that patient confidence in their healthcare team was a facilitator in patients with type 2 diabetes. The relationship with healthcare providers can become a barrier to adherence when communication problems emerge or when time and empathy are lacking.…”

Factors Associated with Participation in Diabetes Education: The Korea National Health and Nutrition Examination Survey 2007 to 2009

“…However, few studies have investigated the factors associated with patient participation in prescribed diabetes education programs [14151617]. …”

Low uptake of postpartum screening for Type 2 diabetes in women after a diagnosis of gestational diabetes

“…High BMI was the only demographic factor associated with the uptake of screening. This may relate to hesitancy in this population to make lifestyle changes to manage their diabetes risk, or obesity may be a proxy marker for deprivation.More than 40% of our cohort were from an Asian background, in whom language and communication may be a barrier to understanding information given by healthcare professionals [7]. Postnatal diabetes leaflets written in different languages may make the information accessible.…”