BME communities and self-management of long term conditions

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The UK has an ever more diverse society and ethnic minority groups are growing. Due to the great heterogeneity of ethnic minorities and their vastly different cultural backgrounds, their health and social care needs may differ from one another, and from the indigenous population. That’s why ethnic minorities need targeted services to truly meet their needs.

In fact, health problems such as diabetes and chronic heart disease (Barnett et al., 2006; Forouhi et al., 2006), but also dementia, are high and rising in black, Asian and minority ethnic groups.

This systematic review by Sidhu and colleagues (2014) discussed here focuses on the first set of health problems, diabetes and chronic heart disease, amongst others, as examples of chronic diseases. The authors have looked at how such chronic diseases in ethnic minorities can effectively be managed through self-management programmes (CDSMPs).

The authors have looked at how such chronic diseases in ethnic minorities can effectively be managed through self-management programmes

The authors have looked at how chronic diseases in ethnic minorities like diabetes can be effectively managed through self-management programmes.

Methods

In this systematic review, the authors searched for literature on several databases, including MEDLINE, EMBASE, CINAHL, ISI Web of Knowledge, Science Direct, Sociological Abstracts, the Cochrane Central Register of Controlled Trials, and Literatura Latino Americana em Ciencias da Saude.

Studies in English published between January 1948 and July 2013 were included. Of nearly 30,000 studies showing up in the database searches, 216 full articles were read and assessed for inclusion into the review.

In the end, 28 studies were included, 16 of which were randomised controlled trials.

Results

The review showed that user-led group-based self-management interventions in ethnic minorities frequently resulted in improvements in cognitive factors, such as distress, pain, fatigue, self-efficacy and self-reported health. Only minor effects were noted for clinical outcomes such as reduced blood pressure and reduced BMI.

Most interventions were based on theories aimed at modifying behaviour. Interestingly, when comparing the effects of interventions with and without the integration of theory, those without theoretical underpinnings showed no effects on clinical outcomes, whereas those with theory did. This seems to be expected considering that modifying one’s behaviour to practice more physical exercise has a direct effect on reduced blood pressure and BMI.

An interesting aspect picked up by the authors was the adaptation of the interventions to suit the minority groups. The authors highlighted that the interventions integrated the cultural beliefs and practices, as well as were structurally modified so as to improve their attendance and completion.

ser-led group-based self-management interventions in ethnic minorities frequently resulted in improvements in cognitive factors, such as distress, pain, fatigue, self-efficacy and self-reported health. Only minor effects were noted for clinical outcomes such as reduced blood pressure and reduced BMI.

There were improvements in cognitive factors such as distress and pain, with minor effects noted for clinical outcomes.

Strengths and limitations

The review in itself is of good quality, and is based on meticulous literature searches and inclusion criteria. However, based on the evidence collected, the findings of this review are not that generalisable to most Western countries, considering the large proportion of studies from the United States (24 of 28 included studies).

There appears to be a greater research interest in user-led group-based self-management interventions for ethnic minorities on this part of the globe for some reason, which is difficult to comprehend considering the great cultural diversity of other Western countries, such as the UK, Germany or France.

With most studies from the US, the authors also highlight the limitation that ‘Asian’ for instance is likely to mean something different in the US than it does for instance in the UK. Also, with different types of ethnic minorities in other countries, such as the large population of Turkish and Greek people in Germany, more research needs to be conducted to establish whether these types of interventions are truly effective or dependent on the ethnicity.

One limitation of this review which struck me, and was not mentioned by authors, and for that matter in many other studies, is the missing acknowledgement and discussion of cognitive theory underlying these group-based interventions. Although the authors discussed the theoretical underpinnings of the interventions, and their impact on clinical factors, there was no reference to (a) the application of cognitive theory within the interventions, and (b) the potentially varying outcomes of interventions with and without such theory.

In a recent literature review on cognitive interventions to improve independence in people with dementia (Giebel & Challis, 2015), we showed how critical, but also how little integrated in existing research, cognitive theory is. If you look at the Medical Research Council guidance on developing complex interventions though (MRC, 2000), the integration of theory is vital.

Findings may not be generalisable to European countries as a large proportion of studies were from the United States.

Findings may not be generalisable to European countries as a large proportion of studies were from the United States.

Summing up

In summary, this is an interesting review which does show how effective lay-led group-based self-management interventions can be for ethnic minorities.

Although there has been much more research on health and social care for ethnic minority groups in the past decade (Giebel et al., 2014; Mukadam et al., 2013; Parveen et al., 2013), we still have a long way to go to truly help the very heterogeneous group of different ethnicities in receiving specially tailored treatment, and access services. This review is a good step in that direction.

Link

Sidhu, M.S., Gale N.K., Gill P., Marshall T., Taylor B. & Jolly K. (2014). A systematic review of lay-led group-based self-management interventions for minority ethnic populations diagnosed with long term conditions in high income countries. Diversity and Equality in Health and Care 11 (3-4) pp. 225-236 [Abstract]

References

Barnett, AH, Dixon, AN, Bellary, S, et al. (2006). Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia, 49, 2234-2246. [PubMed]

Forouhi, NG, Sattar, N, Tillin, T, McKeigue, PM, Chaturvedi, N. (2006). Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia, 49, 2580-2588. [PubMed]

Giebel, C.M., Zubair, M., Jolley, D., Bhui, K., Purandare, N., Worden, A., & Challis, D. (2014). South Asian Older Adults with Memory Impairment: Improving Assessment and Access to Dementia Care. International Journal of Geriatric Psychiatry, DOI: 10.1002/gps.4242 [Abstract]

Giebel, C., & Challis, D. (2015). Translating cognitive and everyday activity deficits into cognitive interventions in mild dementia and mild cognitive impairment. International Journal of Geriatric Psychiatry, 30 (1), 21–31. [Abstract]

Medical Research Council (2000). A Framework for the Development and Evaluation of RCTs for Complex Interventions to Improve Health. Medical Research Council: London; 18. [Full Report]

Mukadam, N., Cooper, C., & Livingston, G. (2013). Improving access to dementia services for people from minority ethnic groups. Current Opinions in Psychiatry, 26 (4), 409-414. [PubMed]

Parveen, S., Morrison, V., & Robinson, C.A. (2013). Ethnicity, familism and willingness to care: important influences on caregiver mood? Aging & Mental Health, 17 (1), 115-124. [PubMed]

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Clarissa Giebel

Clarissa is currently a Research Fellow at the University of Liverpool. Her research focuses on enabling people with dementia staying at home for as long as possible, whilst addressing potential health inequalities in accessing the right care. She is currently leading the first Covid-19 dementia study in the UK, exploring the effects of social service closures on the lives of people with dementia and unpaid carers. In her role as postdoctoral research associate at the NIHR ARC NWC, Clarissa is the Principal Investigator on a number of dementia and health inequalities projects. This includes a European Alzheimer's Society funded project into health inequalities in dementia care access in England and the Netherlands, also collecting Young Onset dementia specific data in Australia. Further funded international collaborations in dementia care include Colombia and Chile. She is also involved in the North West Coast Household Health Survey, looking at health inequalities in health service usage across the population. In addition, Clarissa is leading a care home collaboration, where she works jointly with colleagues from the Netherlands on implementing changes to a local Liverpool-based care home and developing a UK Dementia Village. Additional collaborations and projects include working with the Brain Charity evaluating social support groups for people with dementia, and with the Liverpool House of Memories to look into evaluating their intervention for family carers of people living with dementia and care professionals, and trying to roll the intervention out to other neighbourhoods.

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