The impact of culturally competent diabetes care interventions for improving diabetes‐related outcomes in ethnic minority groups: a systematic review

Abstract

Aim: To examine the evidence on culturally-competent interventions tailored to the needs of people with diabetes from ethnic minority groups.Methods: Medline (NHS Evidence), CINAHL and reference lists of retrieved papers were searched from inception to September 2011 and two NHS specialist libraries. Google, Cochrane and DARE databases were interrogated, and experts consulted. Studies were included if they reported primary research on the impact of culturally-competent interventions on outcome measures of any Ethnic Minority Group with diabetes. Paper selection and appraisal were conducted independently by two reviewers. The heterogeneity of the studies required narrative analysis. A novel culturallycompetent assessment tool (CCAT) was used to systematically assess the cultural competency of each intervention.Results: 320 papers were retrieved and eleven included. Study designs varied with a diverse range of service providers. Of the interventions, 64% were found to be highly culturally-competent (scoring 90%-100%), and 36% moderately culturally-competent (70%-89%). Data were collected from 2616 participants on 22 patient reported outcome measures. A consistent finding from ten of the studies was that: any structured intervention, tailored to Ethnic Minority Groups by integrating elements of culture, language, religion, and health literacy skills, produced a positive impact on a range of patient important outcomes. Conclusions:Benefits in using culturally-competent interventions with Ethnic Minority Groups with diabetes were identified. The majority of interventions described as culturally-competent were confirmed as so, when assessed using the CCAT. Further good quality research is required to determine effectiveness and cost-effectiveness of culturally-competent interventions to influence diabetes service commissioners.

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

“…We found that 'any structured intervention, tailored to ethnic minority groups by (Zeh et al, 2012(Zeh et al, , p. 1237. This strengthens the case for further exploring and understanding specific cultural barriers to diabetes healthcare provision.…”

“…The screening and mapping exercise for the papers identified as a result of the search strategy (see Table 1) identified two issues, namely cultural barriers preventing members of ethnic minority groups from accessing effective diabetes care services, which is the focus of this review, and culturally competent healthcare interventions in ethnic minority groups with diabetes, which has been published elsewhere (Zeh et al, 2012). We found that 'any structured intervention, tailored to ethnic minority groups by (Zeh et al, 2012(Zeh et al, , p. 1237.…”

“…Design: observational studies using qualitative or quantitative methods. Randomised controlled trials and quasi-experimental studies are deliberately excluded from consideration in this paper, as they are included in another published review using the same search strategy (Zeh et al, 2012). .…”

“…He extracted data using a revised data extraction form (Zeh et al, 2012;see Box 1). This form was piloted by three reviewers on three random included papers by cross-checking independent notes for consistency.…”

“…Evidence suggests that, where members of susceptible populations are in the minority, they may not receive equitable diabetes care. This is attributed to a mixture of cultural factors and some service providers' lack of cultural competence (Hawthorne et al, 1993;Narayan and Rea, 1997;Cone et al, 2003;Brown et al, 2002;Zeh, 2010;Zeh et al, 2012;Mainous et al, 2007). The National Service Framework for Diabetes stipulates the minimum standards of diabetes care to be offered to all patients, irrespective of ethnicity, language, culture, religion, gender, disability, age and location (Department of Health, 2001).…”