What is “culturally competent” diabetes education and is it effective?

culturally competent

Previous research has shown that structured diabetes education improves outcomes, and that education that is particularised to an individual patient’s cultural background is more effective than education that is not.

This systematic review set out to identify what factors constitute “culturally competent” education, and what their long-term effects are.

Clinical question:

In ethnic minority patients with diabetes, does culturally competent education improve outcomes?

As part of this research, the reviewers developed an instrument to measure the cultural competence of diabetes education programmes.  They only included studies of programmes that scored 70% or higher on this instrument.

The evidence:

11 studies were found, comprising 2,616 patients.  Five of the studies were RCTs, 3 were qualitative studies, two were cohort studies and there was one quasi-experimental study.

There was too much heterogeneity between the studies for confident conclusions to be drawn.  The reviewers concluded that the following key factors influenced the effectiveness of interventions:

  • direct, ongoing communication between patients and professionals
  • expert trainers from the same ethnic background as the patients.

Appraisal hints:

Users of this research should consider:

  • There was a lot of important heterogeneity between studies.  Although the reviewers acknowledge these limitations and rightly emphasise the need for further, focused research on what makes diabetes effective in particular contexts.
  • The lack of clear, prospective definition of the interventions and outcomes of interest is worrying.  This leaves the review open to the possibility of selective reporting and false positive results.
  • Their measure of cultural competence needs to be validated elsewhere.
  • Nevertheless, the review has interesting pointers.


Zeh P, Sandhu HK, Cannaby AM, Sturt JA.  The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review. Diabet Med. 2012 May 4. doi: 10.1111/j.1464-5491.2012.03701.x. [Epub ahead of print]

Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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