title: Long-term conditions, self-management and systems of support: an exploration of health beliefs and practices within the Sikh community, Birmingham, UK.
abstract: The global prevalence of non-communicable diseases (NCDs), such as diabetes mellitus and coronary heart disease, continues to rise. Internationally, people of South Asian origin (i.e. by birth or heritage) are much more likely to develop and live with NCDs compared to the general population. The South Asian diaspora population is highly heterogeneous, varying by socioeconomic status, migration history, religion and ethnicity. This article reports the findings of a study to explore the types of support accessed by Punjabi Sikhs living in Birmingham and the Black Country, UK, who were living with NCDs.
  
  
  
  The study sought to develop a greater understanding of past experiences of accessing support and the importance of relationships in the mobilisation of resources for self-management. It was nested within a larger programme of research which explored attitudes to prevention of chronic diseases in local communities in the region. Seventeen Punjabi Sikh men and women were recruited through purposive sampling. Narrative interviews were conducted and analysed by the research team. Sociological theories on systems of support and social relations were consulted to inform the interpretation of data.
  
  
  
  The study findings suggest that participants interpreted chronic disease self-management in relation to four primary systems of support: health services for disease management; multiple sources of care, including traditional Indian medicines and the Internet, for symptom management; community groups for lifestyle management; and the family for emotional and physical care. Within these systems of support, participants identified barriers and facilitators to the maintenance of a healthy lifestyle. We focus on intra-group diversity; exploring the intersection of views and experiences by age, gender, generation and caste.
  
  
  
  The findings have implications for the design and delivery of primary care and community services which support the prevention and management of NCDs in an increasingly diverse population.
authors.affiliation: a Institute of Applied Health Research , University of Birmingham , Birmingham , UK.
authors.forename: Manbinder S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: b Health Services Management Centre , University of Birmingham , Birmingham , UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Griffith
authors.affiliation: a Institute of Applied Health Research , University of Birmingham , Birmingham , UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
authors.affiliation: a Institute of Applied Health Research , University of Birmingham , Birmingham , UK.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.affiliation: a Institute of Applied Health Research , University of Birmingham , Birmingham , UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
authors.affiliation: b Health Services Management Centre , University of Birmingham , Birmingham , UK.
authors.forename: Nicola K
authors.initials: NK
authors.lastname: Gale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D000529:Complementary Therapies; D054242:Emigrants and Immigrants; D005190:Family / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D000073278:Self-Management / Q000379:methods* / Q000523:psychology*; D012819:Sikkim / Q000208:ethnology; D012944:Social Support; D013222:State Medicine; D006113:United Kingdom; D055815:Young Adult
keywords: Ethnicity; Sikh; South Asian; diabetes; non-communicable disease; self-management