Table 1 Descriptions of included studies To support my qualitative systematic review I included the description of eight articles: Author(s) and Year Type of review Purpose Main argument Who participate Results/ outcomes 1) A. and Walker, E. A (2006) Systematic review qualitative data Provide a description of current research on culturally relevant issues among Hispanic subgroups with diabetes through the United States. “Clinicians and educators would benefit from exploring cultural belief systems with patients, as they may enhance the patient- provider relationship and serve as tools in identifying appropriate treatment strategies” 5997 participants Majority of them of Mexican American heritage. personal models of illness varied across groups and are influenced by acculturation. Clinicians and educators would benefit from exploring cultural belief systems with patients, as they may enhance the patient- provider relationships and serve as tools in identifying appropriate treatment strategies. 2) Hawthorne, Systematic and narrative review – only To determine if culturally appropriate People from ethnic minority groups living in 1603 participants Culturally appropriate health education was
K., Robles, Y., Cannings, J., and Edwards, A. G. K. (appraisal and quality evaluation was done) randomized controlled trial (RCT) were included, eight of the 11 studies based their interventions on qualitative work and 3 on quantitative work. they utilized theoretical models of behavior change, soap dramas, storytelling, and lay workers to deliver health messages, some studies used repeated interventions/classes health education is more effective than “usual” health education for people with diabetes from ethnic minority groups living in high and upper middle income countries. high income or upper income have higher prevalence of type two diabetes, their problems are exacerbated by migrant status, relative deprivation and low socioeconomic status and limited English. Majority of them Spanish speaking and/or Mexican American African American Pakistani British South Asian Surinam Asian more effective than “usual” health education in improving HbA1c and knowledge in the short to medium term. 3)Zeh, P., Sandhu, H. K., Cannaby, A. M., and J. A. (Appraisal assessment- interventions were assess for cultural competency as well) Systematic review 11 studies included five RCT, two qualitative action, two retrospective cohorts, one quasi-experimental design, one qualitative study with focus groups (This review included all ethnic minority groups and all types of diabetes) To examine the evidence on culturally competent interventions, tailored to the needs of people with diabetes from ethnic minority groups. Minority groups do not always receive adequate diabetes care as a result of barriers such as linguistic differences, limited educational backgrounds and religious, health and illness beliefs that are not familiar to the majority population. These cultural characteristics can make minority groups vulnerable within their 2616 participants Asian African American Indian Pakistani Muslim Bangladeshis (Mediterranean Turkish and Caucasian with gestational diabetes) Hispanics. A consistent finding from 10 of the 11studies was that any structured interventions, 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. Authors identified benefits in culturally competent interventions.
host country healthcare system. Culturally and linguistically competent health care professional can confer important benefits, not only to people with diabetes and their families but also for cost saving in every nations’ health care system. 4) Pottie, K., Hadi, A., Chen, J., V., and Hawthorne, K. (2013) A quasi-randomized controlled trial focused on diabetes education intervention for high risk minority population was used. Qualitative methods were conducted to design culturally appropriate interventions. Soap dramas, storytelling, and soap operas were utilized to reach target population Determining how, when and why culturally appropriate interventions work is important for health systems with minority populations The total number of participants from all the studies was 1603. Minority patients with language barriers and limited access to diabetes programs responded to interventions using health workers from the same ethnic group, and interventions promoting culturally acceptable and financially affordable food choices using local ingredients. Program incentives improved retention and this improved levels at least in the short term. Adopting a positive learning environment, a
immediately post intervention. No significant changes in levels of physical activity were found among patients with diabetes or family members. Findings suggest that including family members in educational interventions may provide emotional and psychological support to patients with diabetes, help develop healthy family behaviors and promote diabetes 6) Concha, J. B., Mayer, S. D., Mezuk, B. R., and Avula, D. (2015 Mixed method approach (quantitative and qualitative methodologies) was used to capture numeric observations or participant’s diabetes causations beliefs and contextualize this data with participant’s Explore how cultural diabetes causation beliefs can improve Hispanic/Latino patient Self-management Cultural competence training among health professionals is one of the strategies used for reducing health disparities and ensuring that marginalized racial /ethnic populations receive equitable effective and culturally Total of 13 participants participated in the interventions The top 5 diabetes causation items from the participants included stress or worry, behavior hereditary, diet/eating habits and family problems/worries. Work stress was specifically identified as contributor of unhealthy eating and diabetes. Most
Electronic Search Results Search Engine Used Search Terms Number of Studies identified Number of Studies Excluded Exclusion Criteria Used Academic Research Premier Hand search in diabetes educator journal Electronic Search in electronic diabetes educator journal/SAGE journals Diabetes Cultural Competency Diabetes Cultural Competency Diabetes Cultural competency 1,171 5 10 1, 146 5 7 If study was not focused on diabetes and cultural competency/sensitivity If study did not contain a method section that included information on search strategy. Same above Same above
Figure 1. Flowchart representing the studies identified for and included in the systematic review. Below: Chapter 4: Results Analysis of the articles. Author Needs and Cultural expectations, Ethnic characteristics Cultural competency strategies/intervention Strategy that increase diabetes outcomes? Caban and Walker 2006 Systematic review Some Hispanics relate susto (fright) to the onset of diabetes. Relation between God and living with diabetes (Unknown). Hispanic and use of curanderos for diabetes (limited research) The fact that fatalistic thinking is unique to Hispanics and related to diabetes have limited evidence therefore will remain unclear. NO Clinicians and educators would benefit from exploring the cultural belief systems with patients, they may enhance the patient-provider relationship and serve as tool in identifying appropriate treatments strategies. Hawthorne et al., 2009 Narrative review Minority groups with migrant status and language barriers, relative deprivation and low socioeconomic status. (include Hispanics) Culturally appropriate health education that includes health workers, church based educational sessions and culturally specific dietary educations. Culturally appropriate health education was more effective than usual health education in improving HbA1c and knowledge in the short medium term.
Zeh et al., Systematic review Minority groups with higher risk of developing type 2 diabetes (Include Hispanics) Interventions tailored to the needs of minority groups, these integrated methods like culture, language, religion and health literacy and adapt other methods that met cultural and community needs. Cultural competent strategies improve knowledge Pottie et al., Control Minority patients with language barriers and limited access to diabetes programs (include Hispanics) Culturally appropriate interventions that used health workers from the same ethnic group to promote culturally acceptable and financially affordable food choices using local ingredients and program incentives. They used soap, dramas, storytelling and soap operas. Minority and uninsured migrants with unmet health needs showed the highest participation Improvement in responses from culturally appropriate programs. Hu et al., (2016) Experimental design Hispanics with type 2 diabetes. Family based culturally tailored intervention program A1C decrease to 4.9 Significant improvement in Systolic blood pressure in almost all the participants Improvement in diabetes knowledge Increase intake of healthy food Better performance of blood glucose test Improvement in mass index
Overall improvement in quality of life Overall: including family members in educational interventions may provide emotional and psychological support to patients with diabetes. Concha et al., Focus groups Diabetes causation beliefs: Stress, worry, behavior hereditary, diet/eating habits and family /worries. This is the answer of one patient: “for me I think it was it was hereditary, well because my whole family, my maternal grandparents were not diabetic, but my paternal grandparents, yes, my parents were also diabetic, I think that maybe it came from hereditary or because of food and the stress within ourselves. The stress, maybe because of the stress, the pressure from work or having to work every day to survive and all that, and that work, the work and all of that, the way of life I lead is more busy” Include (Hispanic/Latinos) Culturally competent training semi structure focus group Participants believed that asking patients their diabetes causation beliefs and emotional status can help health professionals better understand the patient and identify and prioritize diabetes treatments. They also think that the role of the doctor is important and the encouragement they give to the patient is clinically and spiritually valued. Cadzow et al., (2013) Community pilot intervention/project Communities of color Community based diabetes education pilot aimed to train and implement cultural health broker to improve community members’ diabetes knowledge and self-management. Trainees increased their diabetes knowledge and confidence to perform a task of a cultural broker. Community participants’ knowledge improve Life style change/improve