Culturally based type 2 diabetes education programs improved patients' glycemic control for at least 6 months, based on results from a meta-analysis of 11 studies involving more than 1,000 patients.
“In some cases, cultural and communication barriers increase the problems minority ethnic communities experience in accessing good quality diabetes health education, a vital aspect contributing towards patient understanding, use of services, empowerment, and behaviour change towards healthier lifestyles,” the reviewers wrote in a report by the Cochrane Collaboration published online.
Overall, findings from the studies showed significant improvement in glycemic control (as measured by hemoglobin A1c levels) at 3- and 6-month follow-ups among patients who received culturally appropriate health education interventions, compared with control patients who received standard health education (described as “usual care”). This finding is clinically important if the improvement can be sustained, the reviewers noted, but the improvement in glycemic control was not significantly different between the groups at 12 months after the intervention.
In addition, patients in the intervention group showed significantly improved knowledge about diabetes and healthy lifestyles, compared with the control group at 3, 6, and 12 months after the intervention.
The report consisted of data from 11 trials including 1,603 individuals at least 16 years old who had type 2 diabetes. The patients were members of ethnic-minority groups in upper-middle-income or high-income countries. Previous studies have suggested that ethnic minorities in these countries have higher rates of type 2 diabetes, compared with the majority populations, and the investigators who conducted the studies theorized that culturally appropriate education would improve diabetes management in ethnic-minority patients. The primary outcome measure was glycemic control.
The studies included in the review took place in Europe, the United States, Canada, South Africa, New Zealand, and Australia. In most of the studies, the intervention was repeated several times for periods lasting from 6 to 12 weeks. None of the studies followed patients for more than 12 months from the start of the intervention (Cochrane Database Syst. Rev. 2008 [doi: 10.1002/14651858.CD006424.pub2]).
Culturally appropriate health education intervention was defined as “education that is tailored to the cultural or religious beliefs and linguistic skills of the community being approached, taking into account likely literacy skills,” the researchers wrote. The intervention strategies varied among the studies and included using community-based health advocates, providing education to same-gender groups, and adapting dietary advice to fit a community's available food options.
No significant improvements were found in most of the other clinical outcomes measured in the studies (including triglycerides, blood pressure, or weight) between patients who received culturally appropriate education intervention and those who received usual care. Total cholesterol was the exception—the intervention patients showed improvement in total cholesterol at 12 months, but not at 3 months or 6 months, compared with the control patients, based on data from the three studies that addressed this outcome.
No significant differences in quality of life were reported between patients who received culturally appropriate diabetes education and those who received standard education, according to findings from the three studies that addressed quality of life.
Despite the short duration of improvement, the findings suggest that culturally appropriate education programs can make a significant difference in diabetes control and are worth developing, the reviewers said.
“It has been known for some time that diabetes health education improves knowledge about diabetes as well as blood glucose control, but this review has shown that culturally appropriate health education is better than 'normal' practice for minority communities,” they wrote. “The results strengthen the belief, based on educational theory, that health education should be couched in a learner-centered manner that respects their religious, social, and cultural values in order to have the most impact.”
The lead review author, Dr. Kamila Hawthorne of Cardiff (Wales) University, was the author of one of the studies included in the review. The other reviewers had no conflicts of interest to disclose.