Cultural Influences on Dietary Self-Management of Type 2 Diabetes in East Asian Americans: A Mixed-Methods Systematic Review

Abstract

Purpose: Many East Asian Americans (EAAs) (populations originating from China, Korea, Japan, and Taiwan) with type 2 diabetes mellitus (T2DM) experience unique challenges in managing their disease, including language barriers and traditional cultural beliefs, particularly among first-generation immigrants.. The purpose of this mixed-methods systematic review was to examine cultural perspectives of EAAs that influence dietary selfmanagement of T2DM and identify education interventions and their approaches to enhance EAAs' dietary self-management of diabetes. Methods: A mixed-methods systematic review was conducted to examine EAAs' perspectives from qualitative studies and to identify education interventions and their approaches from quantitative studies. A literature search was conducted using PubMed/MEDLINE, SCOPUS, CINAHL, and Web of Science from 1995 to 2018. Sixteen studies (10 qualitative and 6 quantitative) met criteria for analysis. Thematic synthesis of qualitative data was conducted using a line-by-line coding strategy. Extracted quantitative data were assessed for cultural approaches used in the interventions and diabetes-related outcomes. Results: In the qualitative studies, beliefs about food impacted EAAs' abilities to adopt appropriate dietary recommendations for diabetes management. Requiring a specialized diet disrupted social harmony and made EAAs feel burdensome to others. Having bilingual and bicultural resources eased the stress of making dietary modifications. The most commonly incorporated approaches in diabetes education interventions were bilingual education and culturally specific dietary recommendations. Social roles and harmony were not discussed. Significant reductions in hemoglobin A1c and increases in diabetes knowledge were reported post-intervention. Conclusions: Beliefs about food, beliefs about social roles, and access to culturally competent care play an important role in dietary self-management of T2DM among EAAs. Understanding the cultural influences on dietary self-management of T2DM and tailoring interventions to meet the needs of EAAs are essential in effort to address the growing epidemic and improve patient outcomes.

The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews

“…Culturally Defined Roles and Perceptions Religious beliefs or cultural backgrounds could affect patients' willingness to improve their health [ 54 , 57 , 83 , 94 , 96 , 98 , 110 , 115 , 119 , 122 , 136 , 156 ]. In T2DM, patients from ethnic minorities living in Western countries found it challenging to follow dietary, activity, or treatment (insulin) recommendations that conflicted with their beliefs or traditions [ 54 , 122 , 130 , 135 , 138 , 139 ]. Patients from ethnic minorities with HF were less likely than Western patients to adhere to an SM programme [ 136 ].…”

“…Some nurses in charge of patients with COPD perceived an absence of individualised care [ 44 ]. When exploring participants' perceptions of culturally tailored interventions, most reported feeling motivated, supported, and empowered [ 138 , 173 ].…”

“…This theory outlines the process of self-regulation, describing how people internalise social values and extrinsic contingencies, thereby moving from controlled to autonomously motivated behaviours that align with personal values and goals [ 185 ]. Our findings reflect some mechanisms that patients use to change their behaviours, such as (1) competence (e.g., in COPD and HF, patients gain expertise about their body responses, which helps them adopt a regulatory role and adjust their lifestyle [ 41 , 73 , 92 , 112 ]); (2) autonomy (e.g., in COPD, adjustments or behaviour modifications were sometimes driven by patients’ motivation to prevent exacerbation [ 45 , 73 , 74 ] and physical activity motivation was driven by the expected or experienced benefits [ 87 , 124 , 126 , 132 , 153 ]), and (3) relatedness (e.g., patients from ethnic minorities living in Western countries found SM recommendations challenging when they conflicted with their beliefs or traditions [ 54 , 122 , 130 , 135 , 138 , 139 ]).…”

A qualitative study of self‐management experiences in people with non‐alcoholic fatty liver disease

“…East Asian countries are characterized by family-centred cultures, in which the family plays a statistically significant role in a patient's self-management behaviour (Chen et al, 2016;Wah et al, 2019). Moreover, in South Korea and China, people traditionally view healthy food as medicine, which can boost one's health (Kyung Chung, 2015;Lee, 2014;Li-Geng et al, 2020).…”

Dietary Characteristics and Influencing Factors on Chinese Immigrants in Canada and the United States: A Scoping Review

“…Moreover, a literature review of dietary patterns and influencing for Arabic-speaking immigrants and refugees in Western societies highlighted a gap in nutrition research for their respective immigrant groups [ 12 ]. Two literature reviews, which focused on Chinese immigrant populations, examined dietary behaviours in the context of specific diseases such as diabetes and focused on cultural influence [ 13 , 14 ]. Thus, there is a need to better synthesize the evidence on the specific dietary practices, changes, and influencing factors of Chinese immigrant groups.…”