People in black and minority ethnic (BME) groups have a higher risk of type 2 diabetes than the population as a whole and often experience difficulty in managing their condition.
A recent systematic review looked at their experiences of self-management of type 2. This information will be extremely valuable to those running services for BME patients with type 2 diabetes who wish to improve their care.
The review question
- In BME adults with type 2 diabetes, what are patients’ views on self-management?
This was a systematic review of qualitative data with a thematic synthesis. The reviewers searched for studies that reported patients’ views as data. Their literature search was comprehensive, and, usefully, is reported in full in an online supplement. They also validated the sensitivity of the search by hand searching for papers in a leading diabetes journal.
Qualitative data from the studies was extracted and cloded according to a four-step thematic synthesis approach.
57 studies were found that met the inclusion criteria. 41 were from North America, 14 from Europe and 2 from Australia, comprising a total of 1,735 participants.
The reviewers identified three analytical themes:
- Importance of identity: emotional issues, confidence and roles, including gender roles
- Being understood by others: health professionals, family and social stigma
- Making sense of my own condition: education, knowledge, attitudes and behaviours (including diet, exercise and medication use) and beliefs about cause.
They viewed these themes as being closely related, within an over-arching theme they called “sense of self”:
An individual’s perception of their condition was in part influenced by their self-identity before and after diagnosis. Furthermore, it was important to patients that others understood their (perception of their) condition.
The reviewers recommend that successful interventions should:
- take a patient-centred, experiential approach to learning how to manage diabetes
- utilise existing peer, family and social networks.
However, the full text of the review contains a wealth of detail about views on diet, self-monitoring of blood glucose, medication and insulin use and exercise.
The study is focused on BME groups living as ethnic minorities in Western countries
- The reviewers took great care to ensure that their literature search was comprehensive and accurate
- However, they did limit themselves to English language studies.
- The search was carried out in April 2008. It seems likely that further important research has been published since, particular in areas of new technology such as insulin pumps
- The reviewers had to develop or adapt tools for study selection, data extraction and quality assessment
- Study selection and data extraction was not done by two blind, independent reviewers. They did check a sample of 10% of the studies to check for errors
- Although the studies varied in their methodological quality, the lower quality studies did not differ in terms of their content.
Majeed-Ariss R, Jackson C, Knapp P & Cheater FM. A systematic review of research into black and ethnic minority patients’ views on self-management of type 2 diabetes. Health Expectations 2013, May 27. doi: 10.1111/hex.12080. [Epub ahead of print] [PubMed abstract]