title: Realist review to understand the efficacy of culturally appropriate diabetes education programmes.
abstract: OBJECTIVE
  Minority populations often face linguistic, cultural and financial barriers to diabetes education and care. The aim was to understand why culturally appropriate diabetes education interventions work, when they work best and for whom they are most effective.
  
  
  METHODS
  This review used a critical realist approach to examine culturally appropriate diabetes interventions. Beginning with the behavioural model and access to medical care, it reanalysed 11 randomized controlled trials from a Cochrane systematic review and related programme and training documents on culturally appropriate diabetes interventions. The analysis examined context and mechanism to understand their relationship to participant retention and statistically improved outcomes.
  
  
  RESULTS
  Minority patients with language barriers and limited access to diabetes programmes responded to interventions using health workers from the same ethnic group and interventions promoting culturally acceptable and financially affordable food choices using local ingredients. Programme incentives improved retention in the programmes and this was associated with improved HbA(1c) levels at least in the short term. Adopting a positive learning environment, a flexible and less intensive approach, one-to-one teaching in informal settings compared with a group approach in clinics led to improved retention rates.
  
  
  CONCLUSIONS
  Minority and uninsured migrants with unmet health needs showed the highest participation and HbA(1c) responses from culturally appropriate programmes.
authors.affiliation: Departments of Family Medicine and Epidemiology and Community Medicine, Elisabeth Bruyère Research Institute, Ottawa, Ontario. kpottie@uottawa.ca
authors.forename: K
authors.initials: K
authors.lastname: Pottie
authors.forename: A
authors.initials: A
authors.lastname: Hadi
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: V
authors.initials: V
authors.lastname: Welch
authors.forename: K
authors.initials: K
authors.lastname: Hawthorne
mesh_terms: D003920:Diabetes Mellitus / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D006301:Health Services Needs and Demand; D006801:Humans; D054525:Minority Health / Q000208:ethnology; D010353:Patient Education as Topic / Q000379:methods*; D011787:Quality of Health Care