Journal of Diabetes Research / 2016 / Article / Tab 1

Review Article

Meeting the Challenge of Diabetes in Ageing and Diverse Populations: A Review of the Literature from the UK

Table 1

Proposed CMOs (context, mechanism, and outcomes) and explanatory concepts for theory building.

Mapped area of literatureContextMechanismExplanatory concept
cultural competency (CC), stratification (S), access (A)
Outcome

Age and South Asian ethnicity in diabetes research and policy: demography and inequality(i) No specific focus on age and ethnicity in the research literature
(ii) National frameworks and nonspecific guidelines
(iii) Local level focus for interventions: community, family, primary care
(i) Cultural adaptation within services, for example, link workers
(ii) Targeting cultural & social factors, for example, families, diet
(iii) Ethnicity as risk factor for inequality in access
(i) CC
(ii) CC, S
(iii) CC, S, A
(i) Modest impacts to date, not cost effective: difficult to do & complex
(ii) Cultural and social determinants can influence motivation & support for self-management
(iii) Researching inequalities to include age dimension

South Asians and earlier onset of diabetes and complications(i) Earlier onset of diabetes and complications
(ii) Primary/secondary care interrelations
(iii) National frameworks for quality diabetes & kidney care
(i) Quality initiatives for diabetes care in primary care
(ii) Use of ethnicity data, referral patterns, progression rates
(iii) System wide & pathway interventions
(i) CC, A
(ii) CC, S
(iii) CC, S, A
(i) Earlier diagnosis
(ii) Improved diabetes care: monitoring & referral patterns
(iii) Contested/better understanding quality improvements in relation to holistic diabetes care

South Asian ethnicity, heterogeneity, cardiovascular disease(i) Heterogeneity within ethnicity
(ii) Socioeconomic associations
(iii) Diversity of outcomes as basis of individualised care
(i) Practice based research into stratification within diabetes populations
(ii) Tailored approaches to diabetes & complications care
(i) S
(ii) S, CC
(i) Targeted care
(ii) Improved understanding of ethnicity influences
(iii) Tackling the biological with the sociological

Diabetes and complications affecting older South Asian people(i) Age and high prevalence of diabetes comorbidities & complications
(ii) Early onset, increased risk, faster progression
(iii) Extended timeframe of care
(i) System approaches: care pathway & disease trajectories
(ii) Improved identification of comorbidities, for example, dementia & depression in older people with South Asian background
(i) S, A
(ii) S
(i) Shift in the way we think about diabetes and ageing
(ii) Prevention, identification, treatment & end of life care across different settings

Delivering quality diabetes care and prevention of complications in UK South Asian population(i) Person centred care & assessment of need
(ii) Quality care includes knowledge & information for patients
(iii) Lack of evidence about cultural aspects of self-management
(iv) More evidence which includes South Asian ethnicity required
(i) Cultural flexibility within care
(ii) Improving access by better identification through screening
(iii) Integrated care as part of a holistic and whole coordinated approach
(i) CC, A
(ii) A, S
(iii) S, A
(i) Better understanding of the different elements of diabetes care
(ii) Access increased through combined and system wide approaches.

Researching the experience of older South Asian people with diabetes in and across different settings(i) Lack of research involving South Asian patients
(ii) Reliance on studies of ethnicity in kidney services
(iii) Broader social and psychological contexts of care
(i) Culturally competent practice and research to redress inequalities in access & in research participation(i) CC, A(i) Improved understanding of patient experience so that care is effective and meaningful for all patients.

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