title: New models of self-management education for minority ethnic groups: pilot randomized trial of a story-sharing intervention.
abstract: OBJECTIVE
  no model of self-management education or peer support has yet achieved widespread reach and acceptability with minority ethnic groups. We sought to refine and test a new complex intervention in diabetes education: informal story-sharing groups facilitated by bilingual health advocates.
  
  
  METHODS
  pilot randomized trial with in-depth process evaluation in a socioeconomically deprived area. 157 people referred for diabetes education were randomized by concealed allocation to an intervention (story-sharing group in their own language) or control ('usual care' self-management education, through an interpreter if necessary) arm. Story-sharing groups were held in five ethnic languages and English (for African Caribbeans), and ran fortnightly for six months. Primary outcome was UKPDS (UK Prospective Diabetes Study) risk score. Secondary outcomes included attendance, HbA1c, well-being and enablement. Process measures included ethnographic observation, and qualitative interviews with staff and patients.
  
  
  RESULTS
  some follow-up data were obtained on 87% of participants. There was no significant difference between intervention and control arms in biomedical outcomes. Attendance was 79% in the story-sharing arm and 35% in the control arm (p < 0.0001), and patient enablement scores were significantly higher (8.3 compared to 5.9, p < 0.005). The model was very popular with clinicians, managers and patients, which helped overcome numerous challenges to its successful embedding in a busy public sector diabetes service.
  
  
  CONCLUSIONS
  people from minority ethnic groups in a socioeconomically deprived area were keen to attend informal story-sharing groups and felt empowered by them, but clinical outcomes were no better than with conventional education. Further research is needed to maximize the potential and evaluate the place of this appealing service model before it is introduced as a part of mainstream diabetes services.
authors.affiliation: Queen Mary University of London, London. p.greenhalgh@qmul.ac.uk
authors.forename: Trisha
authors.initials: T
authors.lastname: Greenhalgh
authors.forename: Desirée
authors.initials: D
authors.lastname: Campbell-Richards
authors.forename: Shanti
authors.initials: S
authors.lastname: Vijayaraghavan
authors.forename: Anna
authors.initials: A
authors.lastname: Collard
authors.forename: Farida
authors.initials: F
authors.lastname: Malik
authors.forename: Mark
authors.initials: M
authors.lastname: Griffin
authors.forename: Joanne
authors.initials: J
authors.lastname: Morris
authors.forename: Anne
authors.initials: A
authors.lastname: Claydon
authors.forename: Fraser
authors.initials: F
authors.lastname: Macfarlane
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy; D005006:Ethnicity / Q000193:education*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000193:education*; D019303:Multilingualism; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011204:Poverty Areas; D011209:Power, Psychological; D011446:Prospective Studies; D036301:Qualitative Research; D012648:Self Care; D012657:Self-Help Groups