title: Barriers and Facilitators for Type-2 Diabetes Management in South Asians: A Systematic Review.
abstract: OBJECTIVE
  Although South Asian populations have among the highest burden of type 2 diabetes in the world, their diabetes management remains poor. We systematically reviewed studies on South Asian patient's perspectives on the barriers and facilitators to diabetes management.
  
  
  METHODS
  We conducted a literature search using OVID, CINHAL and EMBASE (January, 1990 -February, 2014) evaluating the core components of diabetes management: interactions with health care providers, diet, exercise, and medication adherence. South Asian patients were self-reported as Indian, Pakistani, Malaysian-Indian or Bangladeshi origin. From 208 abstracts reviewed, 20 studies were included (19 qualitative including mixed methods studies, 1 questionnaire). Barriers and facilitators were extracted and combined using qualitative synthesis.
  
  
  RESULTS
  All studies included barriers and few facilitators were identified. Language and communication discordance with the healthcare provider was a significant barrier to receiving and understanding diabetes education. There was inconsistent willingness to partake in self-management with preference for following their physician's guidance. Barriers to adopting a diabetic diet were lack of specific details on South Asian tailored diabetic diet; social responsibilities to continue with a traditional diet, and misconceptions on the components of the diabetic diet. For exercise, South Asian patients were concerned with lack of gender specific exercise facilities and fear of injury or worsening health with exercise. Patients reported a lack of understanding about diabetes medication management, preference for folk and phytotherapy, and concerns about the long-term safety of diabetes medications. Facilitators included trust in care providers, use of culturally appropriate exercise and dietary advice and increasing family involvement. Overall themes for the barriers included lack of knowledge and misperceptions as well as lack of cultural adaptation to diabetes management.
  
  
  CONCLUSIONS
  Diabetes programs that focus on improving communication, addressing prevailing misconceptions, and culture specific strategies may be useful for improving diabetes management for South Asians.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Sohal
authors.affiliation: Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Parmjit
authors.initials: P
authors.lastname: Sohal
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: King-Shier
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation for Outcomes Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
mesh_terms: D001459:Bangladesh; D003142:Communication; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D019468:Disease Management; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D010154:Pakistan; D010817:Physician-Patient Relations