A number of reports indicate that cultural barriers may prevent members of ethnic minority groups from accessing diabetes services, but little is known about the specific nature of these barriers. This systematic review of observational studies aimed to identify and explore cultural barriers as a basis for improvements in care. Articles published from inception to September 2011 were retrieved from four databases Medline, CINAHL, Cochrane and DARE), two National Health Service specialist libraries (Diabetes, and Ethnicity and Health), Warwick Medical School publications and reference lists. Inclusion criteria were qualitative or quantitative studies involving ethnic minority groupswith diabetes. Two reviewers independently conducted paper selection and appraisal. A total of 316 studieswere retrieved, 22 of which were included in the review. Due to the heterogeneity of the studies, a narrative analysis was undertaken. Eight key cultural issues emerged, namely participants’ strong adherence to cultural norms, religious beliefs, linguistic diversity, low health literacy levels, different beliefs about health and illness, belief in expert and professional support, low accessibility of culturally appropriate services/information, and low concordance with western professional advice. These issues compromised the level of diabetes care services received by members of ethnic minority groups. It is recommended that further attention is given to the development of culturally competent interventions for improving access to healthcare and diabetes outcomes for members of specific ethnic minority groups.
Peter Zeh, Harbinder K Sandhu, Ann Marie Cannaby, Jackie A Sturt