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Background
In the United States, Asian immigrants’ populations are growing rapidly. In addition, Asian immigrants have a higher prevalence of diabetes diagnosis due to change of diet and lifestyle than other ethnicities. Many hospitals and clinics have offered diabetes programs, but care to ethnic minorities still remains inadequate, ineffective, and inaccessible. Language barriers and lack of health care insurance are the main contributing factors for the lack of effective programming. For these populations, a culturally-tailored diabetes intervention is needed.
Cultural tailoring is defined as “employing the native language, integrating cultural dietary preferences, encouraging family participation and support, and holding open discussions of cultural beliefs and treatment practices for diabetes (e.g., home remedies, oriental medicine).”
A culturally-tailored diabetes program is imperative because the increasing numbers in minority populations with diabetes in the United States. In a west-coast state such as California, which has a large population of Asian immigrants, the prevalence of diabetes is growing fast.
To date, several studies have shown that a culturally sensitive diabetes program results in benefits to Hispanics and Asian immigrants. Some studies showed that culturally adapted education programs were associated with increases in Asian immigrants’ heath behavior and increase use of clinic services. In the local community health centers and churches, a culturally tailored diabetes program has been offered to Korean American, Chinese American, and Hispanic diabetics.
However, the study of culturally-tailored program is still on developing stages especially for Asian immigrants, thus, a critical review of its effectiveness is needed. The effectiveness of these programs needs to be systematically reviewed to ensure the evidence-based nursing practice for those immigrant populations.
Purpose
The purpose of this systematic literature review is to examine the effectiveness of culturally-tailored diabetes management programs and outcomes for Asian immigrants in the community. Through this review, the study seeks to assess evidence-based culturally-tailored diabetes practice effectiveness.
Methods
To examine effectiveness of culturally-tailored diabetes programs, a literature review was conducted with PubMed, CINAHL, and PsycINFO to retrieve primary studies published from 1999 to 2013. The key words to search the literature included: Asian immigrant, Asian-American, ethnic minority, diabetes mellitus, culturally-tailored, intervention, education, program, and community-based participatory research. The study search was limited to English-language and empirical studies.
Results
The initial search strategies retrieved 259 articles. All retrieved articles were reviewed abstract first and then fully examined and reviewed for the purpose of this study. In total 12 Asian immigrant studies were selected for critical review.
Quality of studies was assessed by methodological quality tool. All 12 studies show moderate to low quality. Five studies were randomized controlled trials and the rest of studies were pilot or quasi-experimental studies.
Among twelve studies, nine studies were conducted in the United States with Korean-American, Chinese-American, and South-Asian immigrants. Three studies were conducted with South Asian immigrants in the United Kingdom and Canada. The total sample included in the 12 studies included sample size under 100 (n = 7) and over 100 (n = 5). All twelve studies’ population was adults who are more than 40 year old.
The culturally-tailored programs consisted with culturally sensitive diabetes education, behavioral intervention, diet-specific program, counseling, and self-management education. Most interventions were delivered by bilingual nurses and the duration of interventions varied from 6 weeks to 8 months.
Retrieved studies showed two common benefits from culturally-tailored programs: 1) improvements in objective clinical outcomes and 2) positive psychobehavioral outcomes. Most of studies reported that culturally-tailored interventions were significantly effective in improving glycemic control, HbA1c. Also, there are significant reductions in body mass index and blood pressure in intervention group compared to control group. Retrieved studies reported that patients who engaged the intervention were highly satisfied, emotional support, high quality of life scores, and increased diabetes knowledge.
Conclusion
There is an evidence based effectiveness of culturally-tailored diabetes intervention with Asian immigrant population. This systematic review displays that culturally-tailored diabetes program is effective improving patients’ objective clinical outcomes and patients; emotional support. Also, patients were satisfied with bilingual health care professions and bilingual education materials.
Implications
Asian immigrants are fast increasing in the United States and prevalence of diabetes with those populations is continuously rising. Asian immigrants may underestimate to their health status and risk for chronic illnesses, however, there is increasing burden of health care cost related to diabetes in Asian Americans. Nevertheless, these populations have limited access to health care management services because of financial difficulties and English deficiency,
Culturally-tailored diabetes intervention is a culturally sensitive, efficient, and effective management for immigrant populations, thereby reducing health disparities. This program is imperative to management because the populations of minority diabetes are increasing and those populations have different social, cultural, and behavioral factors.
Under the Affordable Care Act, this culturally-tailored diabetes program is an important initiative for ethnic minority community, but further research is needed with large Asian subgroup with longitudinal analysis.
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