title: A critique of the design, implementation, and delivery of a culturally-tailored self-management education intervention: a qualitative evaluation.
abstract: BACKGROUND
  Self-management education is at the forefront of addressing the increasing prevalence of chronic diseases. For those at greatest risk, such as minority-ethnic and/or socio-economically deprived groups, self-management education can be culturally-tailored to encourage behavioural change. Yet, the application of culturally appropriate material and expertise within health promotion services continues to be debated. We critique the design, implementation, and delivery of a culturally-tailored self-management intervention, with particular focus on the experiences of lay educators.
  
  
  METHODS
  A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). We interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages.
  
  
  RESULTS
  Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator's cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness.
  
  
  CONCLUSIONS
  Lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the 'community' links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. m.s.sidhu@bham.ac.uk.
authors.forename: Manbinder S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. n.gale@bham.ac.uk.
authors.forename: Nicola K
authors.initials: NK
authors.lastname: Gale
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. p.s.gill@bham.ac.uk.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. t.p.marshall@bham.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. c.b.jolly@bham.ac.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003142:Communication; D054521:Cultural Competency; D036861:Delivery, Obstetric; D019468:Disease Management; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D010353:Patient Education as Topic; D011247:Pregnancy; D036301:Qualitative Research; D012648:Self Care; D055815:Young Adult