Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes

Abstract

Aims With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. Methods We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context – the influence and mitigation of a range of individual, socio-cultural, and environmental factors. Results We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. Conclusions A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.

A Qualitative evaluation in community settings in England exploring the experiences of coaches delivering the NHS Low Calorie Diet programme pilot to ethnically diverse participants

“… 9 Furthermore, studies exploring the impact of cultural tailoring on diabetes management among ethnic minority populations found that tailored interventions, including language-appropriate resources and culturally sensitive advice, are needed to promote uptake and adherence. 39 The lack of cultural competency in healthcare can exacerbate existing health inequalities within ethnically diverse populations, reflecting a fundamental inequity in access and quality of care. 40 Studies have demonstrated disparities in health outcomes among minority groups, partly due to cultural insensitivity in interventions and healthcare delivery.…”

Views of children with diabetes from underserved communities, and their families on diabetes, glycaemic control and healthcare provision: A qualitative evidence synthesis

“…The findings from this QES have informed the design and conduct of ongoing primary qualitative work that aims to explore the management of diabetes in CYPD and family/caregivers from underserved communities and the healthcare professionals who care for them. This primary qualitative research, together with this QES and two systematic reviews will inform the development, in partnership with CYP and their families, of culturally acceptable intervention packages 17,62,63 . These will be based on models of community liaison keyworkers, targeting education and behaviour change, addressing the specific personal, family, cultural and community barriers to optimal glucose control faced by these groups with Type 1 or Type 2 diabetes.…”

“…This primary qualitative research, together with this QES and two systematic reviews will inform the development, in partnership with CYP and their families, of culturally acceptable intervention packages. 17,62,63 These will be based on models of community liaison keyworkers, targeting education and behaviour change, addressing the specific personal, family, cultural and community barriers to optimal glucose control faced by these groups with Type 1 or Type 2 diabetes.…”

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

“…However, in developed countries, the benefits of self-management are not realised in minoritized communities more vulnerable to the cultural and social barriers which impact engagement with diabetes care more broadly, and specifically with self-management support ( 10 , 11 ). These barriers include health literacy, cultural stigma, a lack of personal resource, the severity of the condition, and broader factors involving the healthcare system and the interaction with care providers ( 10 , 12 – 15 ) (as summarised in Figure 1 ).…”

“…With the increasing prevalence of T2DM in minoritized communities, it is important to identify and understand which components of self-management interventions might be best placed to address these barriers ( 15 , 16 ). One approach that has shown promise in T2DM, and other long-term conditions, is the use of individuals linguistically, experientially and ethnically indigenous to target communities in the delivery of diabetes self-management advice and education (DSME) and other aspects of self-management support ( 4 , 17 – 22 ).…”