Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Abstract

Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability.

Cultural barriers impeding ethnic minority groups from accessing effective diabetes care services: a systematic review of observational studies

“…Religious beliefs (Muslim, Christian, Hindu and Sikh) and practices were reported in 12 studies (Greenhalgh et al, 1998(Greenhalgh et al, , 2011Kelleher and Islam, 1994;DuthieNurse, 1998;Hjelm et al, 2005;Lawton et al, 2005Lawton et al, , 2006aLawton et al, , 2007Lawton et al, , 2008Naeem, 2003;Kohinor et al, 2011;Stone et al, 2005;Gonzalez, 2008;Chowdhury et al, 2000). Eleven of these studies reported that participants, especially Muslims, demonstrated a strict commitment to religious beliefs about food and fasting during Ramadan, and diabetes self-management was a secondary consideration.…”

“…Five of these studies identified lack of knowledge about diabetes in ethnic minority groups arising from their inability to communicate in English (Greenhalgh et al, 1998(Greenhalgh et al, , 2011Hjelm et al, 2005;Lawton et al, 2005;Gonzalez, 2008). In three studies, participants preferred linguistically competent healthcare providers to interpreters because they wanted communication to be direct, and interpreters were perceived as a source of anxiety and frustration (Gonzalez, 2008;Brown et al, 2006;Lawton et al, 2006a). Two UK studies (Duthie-Nurse, 1998;Lawton et al, 2006b) reported that linguistic barriers between participants and the public limited participants' knowledge of their neighbourhood and reinforced their vulnerability and social isolation, which led to some participants, especially women, staying indoors.…”

“…In total, 14 studies attributed ineffective diabetes management to communication difficulties and lack of linguistically appropriate healthcare services (Greenhalgh et al, 1998(Greenhalgh et al, , 2006(Greenhalgh et al, , 2011Duthie-Nurse, 1998;Sedgwick et al, 2003;Fagerli et al, 2005;Hjelm et al, 2005;Stone et al, 2005;Lawton et al, 2005Lawton et al, , 2006aLawton et al, , 2006bBrown et al, 2006;Povlsen et al, 2005;Gonzalez, 2008). Five of these studies identified lack of knowledge about diabetes in ethnic minority groups arising from their inability to communicate in English (Greenhalgh et al, 1998(Greenhalgh et al, , 2011Hjelm et al, 2005;Lawton et al, 2005;Gonzalez, 2008).…”

“…some participants expressed disappointment with the inability of service providers to meet their cultural needs due to language differences) Greater trust in the culturally concordant Puerto Rican physicians for their diabetes care service delivery Strong reliance of participants (11 out of 12) on family for support and guidance, such as accompanying them to the physician's office to act as translators and/or providing emotional and physical support Religiosity and spirituality helped the participants to cope with their diabetes, but these two aspects did not influence their decision making Preference for western medicines to treat their diabetes, even though they were aware of culturally based ethno-medicine. Lawton et al (2005Lawton et al ( , 2006aLawton et al ( , 2006bLawton et al ( , 2008 UK 32 adult South Asian patients with type 2 diabetes: Pakistanis (n = 23), Indians (n = 9) Nil Qualitative study using in-depth interviews in participants' first language (English or Punjabi) by a bilingual researcher Strong adherence to traditional diets/food (due to attachment of social and symbolic meanings) despite an awareness of their detrimental effects Strong adherence to religious beliefs about food and fasting during Ramadan, and attribution of beliefs to Allah's will Perceived cultural beliefs included the notion that health, illness and death are pre-ordained by Allah, and that diabetes 'weakened and aged' the body (barrier to physical exercise and stigma associated with diabetes) Strong adherence to cultural norms (e.g. family engagements, business and childcare come first, before their own interests) at swimming pools) or same-sex instructors in gyms, as well as lack of culturally sensitive advice from white health workers with traditional dietary needs Prefer receiving hospital rather than primary care reviews, as perceived services for prompt detection and treatment of complications, rather than provision of advice on management Language barriers leading to lack of diabetes knowledge reinforcing women's vulnerability with regard to the cultural norms of staying indoors Low levels of health literacy among participants Gratitude for the availability of free diabetes services in the UK Low perception of professional competency in India; health workers are financially motivated when prescribing, giving preferential treatment to their relatives …”

“…Of the 22 included studies (see Table 2), 18 used qualitative methods (one used mixed-qualitative methods (Greenhalgh et al, 1998), 13 used in-depth interviews (Kelleher and Islam, 1994;Duthie-Nurse, 1998;Fagerli et al, 2005;Hjelm et al, 2005;Lawton et al, 2005Lawton et al, , 2006aLawton et al, , 2006bLawton et al, , 2007Lawton et al, , 2008, two used focus groups (Greenhalgh et al, 2011;Brown et al, 2006), and two used case study methods (Narayan and Rea, 1997;Fleming et al, 2008). Two studies used mixed methods (Greenhalgh et al, 2006;Lloyd et al, 2008) and three used quantitative methods (Naeem, 2003;Sedgwick et al, 2003;Povlsen et al, 2005).…”