Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies

Abstract

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients’ self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients’ T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument ‘Cultural Conflict’ was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours.

Health professionals interface with cultural conflict in the delivery of type 2 diabetes care

“…SA patients are thought to consider T2D as a social norm (Social Norm Theory, Perkins & Berkowitz, 1986) within their community, a given disease, for which they have limited behavioural influence. This finding is congruent with research exploring the beliefs of SA patients living with T2D (Patel et al, 2021). HPs suggested that patients made social comparisons (Social Comparison Theory, Festinger, 1954) towards others with and without T2D and compared T2D against other health diseases (such as cancer).…”

“…Difficulties in managing such conflict interfere with their interpretation and alignment to any advice received from HPs. As such, SA patients may prioritise their cultural identity before that of their health and T2D status, which may negatively impact their self-management behaviours (Patel et al, 2021).…”

“…Despite clinical guidance and research evidence suggesting that HPs should individualise services and consider cultural and other personal needs of people with T2D, there is a paucity of research exploring HPs' experiences of offering such individual approaches for people with T2D, especially for ethnic minority groups. Previous research has suggested that there is a poor understanding of culture for ethnic minority individuals and how it is applied into clinical practice (Cortis, 2004;Fagerli et al, 2005), and specifically for SA people (Bhurji et al, 2016;Patel et al, 2021;Sohal et al, 2015). However, there is a need to better understand HPs' knowledge and experiences of caring for SA patients with T2D, as there is limited evidence on how to tailor advice for the growing SA population in the UK.…”

Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: A descriptive qualitative study

“…Previous studies identi ed that patients' perceptions of diabetes diagnosis could determine the motivation of self-management engagement [19][20][21][22][23] Suglo and Evans 2012). People who accepted their own diagnosis of diabetes and perceived the diagnosis as a severe condition could be motivated to engage in self-management to achieve better diabetes control engagement [19][20][21][22][23]. However, perception of diabetes diagnosis could be culturally sensitive engagement [19,[21][22][23].…”

The Role of Acceptance and Commitment Therapy in Cardiovascular and Diabetes Healthcare: A Scoping Review

“…A recent systematic review and interpretative synthesis highlights the complex nature of self-management of T2DM. Making lifestyle changes is challenging, and understanding and accounting for the context in which people live, their social influences, cultural and societal norms, the physical environment, and physiological and psychological factors are important [7].…”