Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups

Hawthorne K, Robles Y, Cannings-John R, Edwards AGK

Summary

Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups

In upper-middle income and high income countries, minority ethnic groups often suffer a higher prevalence of type 2 diabetes mellitus than the local population. They also tend to come from lower socio-economic backgrounds, with attendant difficulties in accessing good quality health care. In some cases, cultural and communication barriers increase the problems minority ethnic communities experience in accessing good quality diabetes health education, a vital aspect contributing towards patient understanding, use of services, empowerment and behaviour change towards healthier lifestyles. In this review, 'culturally appropriate' health education is taken to mean any type of diabetes health education which has been specifically tailored to the cultural needs of a target minority group.
The review found eleven randomised controlled trials (RCTs) of culturally appropriate diabetes health education in the world literature that met the selection criteria (participants from a defined ethnic minority group living in a middle income or high income country, over 16 years in age, with type 2 diabetes mellitus, and receiving a culturally tailored health education intervention). Culturally appropriate health education improved blood sugar control in participants, compared with those receiving 'usual' care, at three and six months post-intervention, to be of potential clinical importance if sustained. Knowledge about diabetes, and healthy lifestyles also improved. None of the other clinical outcome measures such as cholesterol, blood pressure or weight showed any improvement, nor were there any improvements in quality of life outcomes for patients.
Studies tended to be of short duration, so longer term outcomes could not be measured. In addition, some outcomes selected by the review were not measured, such as the development of diabetic complications, death rates, or costs of the education programmes. The variation between studies, in terms of the cultural aspects of the populations being studied, the types and duration of the health education being offered to participants, the variety of different outcomes being measured and differences in the timings of these measurements after the health education intervention make interpretation of the findings limited. Although it appears that culturally appropriate health education is potentially more effective than 'usual care' in improving blood sugar control and knowledge of diabetes, with probable attendant benefits to patients, standardised RCTs of longer duration (using the same outcome measures and timings of these measures), are needed with full evaluation of costs.