Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups.
BACKGROUND
Ethnic minority groups in upper-middle and high income countries tend to be socio-economically disadvantaged and to have higher prevalence of type 2 diabetes than the majority population.


OBJECTIVE
To assess the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes.


METHODS
We searched the The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, SIGLE and reference lists of articles. We also contacted authors in the field and handsearched commonly encountered journals.


METHODS
RCTs of culturally appropriate diabetes health education for people over 16 years with type 2 diabetes mellitus from named ethnic minority groups resident in upper-middle or high income countries.


METHODS
Two authors independently assessed trial quality and extracted data. Where there were disagreements in selection of papers for inclusion, all four authors discussed the studies. We contacted study authors for additional information when data appeared to be missing or needed clarification.


RESULTS
Eleven trials involving 1603 people were included, with ten trials providing suitable data for entry into meta-analysis. Glycaemic control (HbA1c), showed an improvement following culturally appropriate health education at three months (weight mean difference (WMD) - 0.3%, 95% CI -0.6 to -0.01), and at six months (WMD -0.6%, 95% CI -0.9 to -0.4), compared with control groups who received 'usual care'. This effect was not significant at 12 months post intervention (WMD -0.1%, 95% CI -0.4 to 0.2). Knowledge scores also improved in the intervention groups at three months (standardised mean difference (SMD) 0.6, 95% CI 0.4 to 0.7), six months (SMD 0.5, 95% CI 0.3 to 0.7) and twelve months (SMD 0.4, 95% CI 0.1 to 0.6) post intervention. Other outcome measures both clinical (such as lipid levels, and blood pressure) and patient centred (quality of life measures, attitude scores and measures of patient empowerment and self-efficacy) showed no significant improvement compared with control groups.


CONCLUSIONS
Culturally appropriate diabetes health education appears to have short term effects on glycaemic control and knowledge of diabetes and healthy lifestyles. None of the studies were long-term, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, standardised multi-centre RCTs that compare different types and intensities of culturally appropriate health education within defined ethnic minority groups.
Hawthorne
Kamila
K
Department of Primary Care and Public Health, Cardiff University, 3rd Floor, Neuadd Meirionnydd Building. School of Medicine, Heath Park, Cardiff, UK, CF14 4XN.
Robles
Yolanda
Y
Cannings-John
Rebecca
R
Edwards
Adrian Gk
AG
D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy*; D006266:Health Education / Q000379:methods; D006801:Humans; D008913:Minority Groups; D010353:Patient Education as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors