Patient access to healthcare services and optimisation of self-management for ethnic minority populations living with diabetes: a systematic review

Abstract

What is known?d People from ethnic minority groups with diabetes have poorer access to healthcare services.d People from ethnic minority groups with diabetes have poorer reported self-management of diabetes.d Culturally adapted programmes may improve outcomes -glycaemic control and service uptake -for patients from ethnic minority groups.What the study adds d A broad and systematic review of studies using mixed methods points to persistent barriers in patient access and self-management of diabetes, particularly for ethnic minority groups with low literacy.d A 'whole systems' approach, targeted at patient, professional and organisational levels, is required to improve patient self-management.d A multidimensional model of 'access', incorporating broader sociocultural factors, is more instructive than a focus on service utilisation alone. AbstractA higher risk of diabetes mellitus in South Asian and Black African populations combined with lower reported access and self-management-related health outcomes informed the aims of this study. Our aims were to synthesise and evaluate evidence relating to patient self-management and access to healthcare services for ethnic minority groups living with diabetes. A comprehensive search strategy was developed capturing a full range of study types from 1995-2010, including relevant hand-searched literature pre-dating 1995. Systematic database searches of MEDLINE, Cochrane, DARE, HTA and NHSEED, the British Nursing Index, CAB abstracts, EMBASE, Global Health, Health Management Information Consortium and PsychInfo were conducted, yielding 21 288 abstracts. Following search strategy refinement and the application of review eligibility criteria; 11 randomised controlled trials (RCTs), 18 qualitative studies and 18 quantitative studies were evaluated and principal results extracted. Results suggest that self-management practices are in need of targeted intervention in terms of patients' knowledge and understanding of their illness, inadequacy of information and language and communication difficulties arising from cultural differences. Access to health-care is similarly hindered by a lack of cultural sensitivity in service provision and under use of clinic-based interpreters and community-based services. Recommendations for practice and subsequent intervention primarily rest at the service level but key barriers at patient and provider levels are also identified.Keywords: access to health-care, diabetes, ethnic minorities, self-management AimsThe aims of the review are to synthesise and evaluate evidence relating to barriers and facilitators in accessing healthcare services and optimising self-management by ethnic minority groups living with diabetes. The review incorporates studies of mixed methods and key findings, which will contribute towards the development and ª

Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis

“…Five recent systematic reviews have focused on resiliency and/or interventions targeting at vulnerable populations with a chronic condition 19,38–41 . Two reviews assessed interventions aimed at improving some aspect of chronic diseases management in ethnic minorities 40,41 .…”

“…Two reviews assessed interventions aimed at improving some aspect of chronic diseases management in ethnic minorities 40,41 . Wilson et al found that access to healthcare is hindered by healthcare providers’ limited awareness of the cultural practices and beliefs of patients 41 . Our review points to the relevance of including a cultural competence approach when working with minority populations.…”

Cultural barriers impeding ethnic minority groups from accessing effective diabetes care services: a systematic review of observational studies

“…However, few studies have explored the effects of cultural and linguistic barriers which may compromise the quality of care delivered to members of ethnic minority groups with diabetes (Davies, 2006;Hill, 2006;Fleming and Gillibrand, 2009). Very little is known about how these barriers may operate in particular societies, and some service providers do not appear to appreciate the nature of these barriers or how they may prevent members of ethnic minority groups from receiving patient-centred diabetes care (Department of Health, 2001;Roberts, 2007;Wilson et al, 2012). A better understanding of these cultural issues may guide healthcare commissioners and clinical commissioning groups (CCGs) to reconfigure diabetes services in primary care, which may improve both care service engagement and outcomes in minority populations (NHS Health Scotland, 2004).…”

Experiences of self-management support from GPs among Australian ethnically diverse diabetes patients: A qualitative study

“…Such burden requires structured support from the health sector including quality multidisciplinary primary health care, participation in diabetes education and access to community support resources (Bodenheimer, Wagner, & Grumbach, 2002). Diabetes patients from ethnic minorities are vulnerable to experiences of sub-optimal care in the health system (Wilson et al, 2012). In Australia, at least a third of people newly diagnosed with diabetes are overseas born (Catanzariti, Faulks, & Waters, 2007) and many of these are from non-English speaking backgrounds (Thow & Waters, 2005).…”