title: A systematic review of interventions to improve diabetes care in socially disadvantaged populations.
abstract: OBJECTIVE
  To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among socially disadvantaged populations.
  
  
  METHODS
  Studies that were included targeted interventions toward socially disadvantaged adults with type 1 or type 2 diabetes; were conducted in industrialized countries; were measured outcomes of self-management, provider management, or clinical outcomes; and were randomized controlled trials, controlled trials, or before-and-after studies with a contemporaneous control group. Seven databases were searched for articles published in any language between January 1986 and December 2004. Twenty-six intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions.
  
  
  RESULTS
  Eleven of 17 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included cultural tailoring of the intervention, community educators or lay people leading the intervention, one-on-one interventions with individualized assessment and reassessment, incorporating treatment algorithms, focusing on behavior-related tasks, providing feedback, and high-intensity interventions (>10 contact times) delivered over a long duration (>or=6 months). Interventions that were consistently associated with the largest negative outcomes included those that used mainly didactic teaching or that focused only on diabetes knowledge.
  
  
  CONCLUSIONS
  This systematic review provides evidence for the effectiveness of interventions to improve diabetes care among socially disadvantaged populations and identifies key intervention features that may predict success. These types of interventions would require additional resources for needs assessment, leader training, community and family outreach, and follow-up.
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, Canada. richard.glazier@utoronto.ca
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.forename: Jana
authors.initials: J
authors.lastname: Bajcar
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Kennie
authors.forename: Kristie
authors.initials: K
authors.lastname: Willson
mesh_terms: D000328:Adult; D019049:Developed Countries; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D010346:Patient Care Management; D010353:Patient Education as Topic / Q000379:methods*; D018802:Patient-Centered Care; D011610:Psychosocial Deprivation; D016032:Randomized Controlled Trials as Topic; D035862:Vulnerable Populations