Diabetes: no patients left behind: with diabetes being most prevalent among black and minority ethnic communities, practitioners across the UK are developing culturally specific services to target them.
Subject: Diabetes (Demographic aspects)
Diabetes (Care and treatment)
Public health (Management)
Author: Ly, Kim
Pub Date: 02/01/2009
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: Feb, 2009 Source Volume: 82 Source Issue: 2
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Product: Product Code: 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs NAICS Code: 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs SIC Code: 8000 HEALTH SERVICES
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 192802935
Full Text: According to the charity Diabetes UK, treating diabetes cost the NHS 1 million [pounds sterling] an hour last year--10% of NHS spending. In 2008, there were 2.3 million people in the UK diagnosed with the condition, but it is especially prevalent in people of black or South Asian origin. Last year, more than 300 000 people from these communities were diagnosed, and Diabetes UK estimates that a further 70 000 were unaware that they had diabetes.

Culturally appropriate services

Unite/CPHVA lead professional officer Cheryll Adams states: 'The best way of reaching any population is often through members of that particular community. It may be that district nurses can recruit "champions" from black and minority ethnic (BME) communities who have diabetes and are willing to provide peer support and education to other community members. With such high levels of diabetes in these communities, it is essential that interventions are targeted and relevant.'


Diabetes UK diverse communities officer Juliet Enever comments: 'It is unknown why diabetes is more prevalent in BME people. What is clear is that it is vital to provide culturally specific information for BME communities. We have found from a number of Diabetes UK roadshows that BME people were more likely to use information that is culturally appropriate and in a language that they understand.'

She adds: 'Tailored and structured diabetes education is the way forward, particularly as 20% of the South Asian community and 17% of the black African and Caribbean community in the UK have type 2 diabetes. Unfortunately, we receive a number of phone calls from healthcare professionals seeking advice on how best to tailor educational groups to meet the needs of BME people, because there are not enough staff trained in providing this type of information.'

Happy hearts

In Gloucester, the role of community diabetes specialist nurse (CDSN) was established in 2005. In addition to making home visits and providing diabetes education for healthcare professionals--including district and practice nurses--the role has since expanded to include projects aiming to improve access to diabetes services for the ethnically diverse population living in this area.

The Khush Dil ('happy heart') project is run by a number of CDSNs with the aim of targeting BME people at risk of developing diabetes.

Gloucestershire Primary Care Trust (PCT) diabetes specialist nurse Gail Pasquall believes that Khush Dil has been a success: 'We have had some great results. Glycaemic control has improved for some patients, and GPs report that the health of patients has improved.'

Despite its success, it has been difficult to get some messages across. At the city's Bartongate Surgery, which took part in the project, some patients stated that the information was hard to apply to their lifestyle. A number of Muslim patients waking up for early morning prayer found it difficult to stick to regular mealtimes. Some recalled that they did not feel like eating breakfast before early morning prayer, while some would eat breakfast twice--before and after prayer.


Gail Pasquall commented: 'Sometimes there are cultural differences that can interfere with how patients manage their condition. But the key is to keep providing the education, reiterate the information and emphasise the importance of a healthy lifestyle and the correct taking of prescribed medicines.'

She adds: 'There are benefits to providing culturally specific services such as the Khush Dil project, but unfortunately there are not enough CDSNs or resources to make this possible.'

Gail, who is also a practice nurse by background, highly recommends diabetes specialist nursing as a career choice for district and practice nurses: 'There is a real buzz in providing education for patients, families and their carers. I found the role very rewarding. Diabetes is a chronic disease, but nurses can make a real difference to a patient's life.'

Your health in your hands

Hounslow PCT also provide structured diabetes education tailored to meet the needs of BME people, and 40% of its population is of South Asian origin. However, local research has found attendance at standard diabetes education groups among older South Asians to be particularly poor.

Hounslow PCT diabetes specialist dietician Rupindar Sahota states: 'Quite often, language and cultural differences, age, location and teaching style may deter this community from attending these classes. Guidelines from the National Institute for Health and Clinical Excellence and Diabetes UK state that all patients should have access to structured educational groups that are tailored to their needs. Therefore, it is important that service provisions are put in place to meet this requirement.' Aap Ki Sehat Aap Ke Haath ('your health in your hands') was set up in 2006. A diabetes dietetic assistant fluent in Hindi and Punjabi (the two most common languages spoken within this community in Hounslow) was employed and trained to deliver the programme.


Classes were held in social settings such as temples and mosques in order to encourage attendance. It was adapted from the X-pert Programme national patient education scheme, but focused on subjects such as modifying Asian cooking techniques to make recipes healthier and how best to manage diabetes if fasting during Ramadan.

Rupindar Sahota noted that the programme has produced good outcomes: 'Attendance has improved, with 75% of attendees turning up to all five sessions. Patient knowledge of diabetes increased, and there was a reduction in body mass index, waist measurements and blood pressure levels.'

She adds: 'Delivering the programme in Hindi and Punjabi helped to overcome communication barriers, and holding sessions in venues such as local temples, mosques or Asian day centres and clubs made patients feel more comfortable and fitted in with their social life. Additionally, myths and misconceptions about diabetes were clarified, including the use of traditional medicines and herbs.'


Targeting the Somali community

Work is also on-going to provide culturally specific diabetes education to BME people in some areas of Wales.

Cardiff has a large Somali community that has existed there for more than 100 years. Diabetes UK Wales, Cardiff University, Atlantic College and local health boards produced a booklet written in both English and Somali on how to manage type 2 diabetes. The story is based on a patient who is newly diagnosed with the condition, and is told following Somali storytelling traditions. It uses images that are culturally relevant, including photos of Somali food and women that reflect Somali cultural norms.

Diabetes UK Wales policy and affairs manager Andrew Misell believes that adapting information for this community is the best way to reach them: 'We know that a lack of understanding of English may mean some Somali people cannot access the healthcare information they need, and that was one reason we prepared this booklet. We realised that culturally relevant education in the Somali language was the best option for many people.'

Elsewhere in the UK

Pilot schemes of culturally specific diabetes classes similar to those held in Hounslow and Gloucestershire have been trialled in Glasgow and Edinburgh, which have made use of interpreters and also provided information to asylum-seekers.

However, there is currently no such service in Northern Ireland, though there have been efforts there to lobby for more structured diabetes education. Responding to this, a spokesperson for the Department of Health, Social Services and Public Safety stated: 'We fully recognise the importance of providing patient-centred services tailored to the particular needs of different client groups. The department is currently examining how best to provide high-quality structured patient education in Northern Ireland in the future, and part of that work will include how to ensure that particular client groups have equitable access to education programmes that are sensitive to their needs.'

Last year, No patient left behind: how can we ensure world-class primary care for BME people? was published, reviewing the reasons why BME clients find it difficult to access GP services. It recommended using examples of good practice to deliver high-quality care for BME patients.

Professor Mayur Lakhani, who led the report, states: 'It is unacceptable that many BME patients still struggle to get the health care that they deserve. Strong action is necessary through the report's recommendations. Our approach is based on the fundamental premise that the NHS should provide services that are personalised to meet the identified needs of patients.' There are a number of projects across the UK such as Khush Dil that follow the report's recommendations. However, frontline practitioners working on such projects have also emphasised that there is a lack of resources, and that much work remains to be done to improve access to primary care for BME people.

Kim Ly

Assistant Editor
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