title: Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives.
abstract: OBJECTIVE
  To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community.
  
  
  METHODS
  Qualitative study (focus groups and semistructured interviews).
  
  
  METHODS
  Tower Hamlets, a socioeconomically deprived London borough, United Kingdom.
  
  
  METHODS
  Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3).
  
  
  METHODS
  17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis.
  
  
  RESULTS
  Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding.
  
  
  CONCLUSIONS
  Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.
authors.affiliation: Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AT. c.m.grace@qmul.ac.uk
authors.forename: Clare
authors.initials: C
authors.lastname: Grace
authors.forename: Reha
authors.initials: R
authors.lastname: Begum
authors.forename: Syed
authors.initials: S
authors.lastname: Subhani
authors.forename: Peter
authors.initials: P
authors.lastname: Kopelman
authors.forename: Trisha
authors.initials: T
authors.lastname: Greenhalgh
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000208:ethnology; D002755:Choice Behavior; D003296:Cooking; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D008131:London; D008297:Male; D012067:Religion; D012923:Social Class