CULTURALLY TAILORED SELF-MANAGEMENT INTERVENTIONS FOR SOUTH ASIANS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW

Abstract

Introduction: As the prevalence of diabetes continues to rise in Canada, South Asians, as the largest visible minority group in Canada, are at higher risk for developing diabetes than the general population. Although diabetes self-management education (DSME) interventions for South Asians with type 2 diabetes (T2DM) have been researched, these interventions have not been assessed for their cultural congruency. Methods: This systematic review examined the effectiveness of DSME interventions for South Asians with T2DM. Electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL and CINAHL) were searched since inception, along with relevant reviews and guidelines. Title and abstract and full text screening were conducted independently by two reviewers; data extraction was done by one reviewer and confirmed by another. Quality assessment of the included studies was completed using the Cochrane Risk of Bias tool; cultural congruency was assessed using Leininger’s Sunrise Model. All results were synthesized narratively. Results: A total of 1259 studies were found in the search, of which only four randomized controlled trials (RCT) met the inclusion criteria. All studies were consistent in showing a reduction in A1C following the intervention; however only one study reported statistically significant reductions in A1C. Interventions were conducted in person, with follow-up periods ranging from six months to two years, with the use of South Asian community link workers in most interventions. Bias was identified across all studies for sequence generation, allocation concealment and blinding. All studies had limited evidence of cultural congruency, particularly for gender roles and responsibilities. Conclusions: This review found limited effectiveness of culturally specific DSME interventions for South Asians with T2DM. Furthermore, the interventions were scant in their description of cultural congruency. Future research ought to begin with designing interventions for cultural congruency and improved methodologies for DSME research to improve internal and external validity.