What are the barriers to primary prevention of type 2 diabetes in black and minority ethnic groups in the UK? A qualitative evidence synthesis

Abstract

This review aimed to synthesise available qualitative evidence on barriers and facilitators to the implementation of community based lifestyle behaviour interventions to reduce the risk of diabetes in black and minority ethnic (BME) groups in the UK. Methods:A search of medical and social science databases was carried out and augmented by hand-searching of reference lists and contents of key journals. Qualitative evidence was synthesised thematically. Results:A total of 13 papers varying in design and of mainly good quality were included in the review. A limited number of intervention evaluations highlighted a lack of resources and communication between sites. A lack of understanding by providers of cultural and religious requirements, and issues relating to access to interventions for users was reported. Behaviour change was impeded by cultural and social norms, and resistance to change. There were variations in the way dietary change and physical activity was approached by different groups and contrasting practices between generations. Conclusions:Qualitative data provided insight into the ways that providers might improve or better design future interventions. Acknowledgement of the way that different groups approach lifestyle behaviours may assist acceptability of interventions. 3 IntroductionIn the UK 100,000 people are diagnosed with type 2 diabetes every year and many more may have the condition (Diabetes UK 2006). Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) are risk factors for type 2 diabetes which together are often described as hyperglycaemia, or Impaired Glucose Regulation (IGR). Between 33% and 66% of people with such risk factors will go on to develop type 2 diabetes over a period of 3-6 years (Diabetes Prevention Programme Research Group 2002;Lindstrom et al. 2003;Pan et al. 1997;Ramachandran et al. 2006). Therefore, identifying and intervening with those at risk could reduce the prevalence of T2DM in the long term (US DPP 2002; Tuomilehto et al 2001). Whilst major international trials have focussed on prevention in populations that already have impaired glucose levels, groups at higher risk due to ethnicity, and / or low socio-economic circumstances may also benefit from targeted intervention.A systematic review of UK literature was carried out to identify available evidence on community promotion of healthy lifestyle behaviours among adults aged 18-74 from black and minority ethnic (BME) groups in the UK. Data for this review was limited to that produced within the UK to increase feasibility in terms of resources, as well as applicability to UK practice. A review of reviews that assesses non-UK evidence on interventions for high-risk groups (low socio-economic groups and BME) is available online (O'Mara et al 2010). This paper reports on the synthesis of this evidence, focussing on barriers and facilitators to the implementation of interventions and behaviour change relating to preventing diabetes and pre-diabetes. A range of study designs was considered including ev...

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