Diversity & Equality in Health and Care Open Access

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Strategies and effectiveness of diabetes self-management education interventions for Bangladeshis

Rahul Alam, Laura Singleton, Jackie Sturt

The study aimed to review the evidence regarding the effectiveness of diabetes health-education trategies used for Bangladeshi populations, who are among the most susceptible of the UK communities for developing diabetes, and unfortunately receive inequitable care. Reducing health inequalities and improving health education for patients living with chronic conditions is central to national policy, and the National Service Framework for Diabetes has set nationwide standards for diabetes health education. The development of effective structured patienteducation programmes is an important public health challenge, and more so for hard-to-reach black and minority ethnic (BME) groups. Such programmes rely on the evidence base, and this review sets out to investigate the effectiveness of health-education strategies used for a vulnerable and particularly high-risk group. The literature was searched using the following databases from inception to August 2008: AMED, CAB Abs, CINAHL, EMBASE, vidMEDLINE(R), PsycINFO, DARE. Cochrane, NIH and the NHS ethnicity and health library. Two reviewers independently assessed studies for inclusion in the review against the following inclusion criteria: a health-education intervention of any setting and type with the aim of providing diabetes-related health education to Bangladeshis. Data were extracted on the participants, interventions, delivery methods, comparison groups and outcome measures. The search strategy revealed four interventions. The authors of the only randomised controlled trial explain that a community lay-led intervention in providing diabetes education was successful, but the benefits were restricted due to a lack of uptake and attendance. Three others have qualitatively described the beneficial effects of link workers/health advocates within the communities, but have not systematically reported outcome measures. The small number of studies retrieved, and the heterogeneity between the studies, make it difficult to make recommendations on particular strategies that are most beneficial to this group. There is an urgent need for further quantitative and qualitative research, including formative, process and outcome evaluations, in order to ascertain the most effective education models for specific minority groups, especially for those who are disadvantaged and more susceptible to disease progression.