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| Mapped area of literature | Context | Mechanism | Explanatory 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 |
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| 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. |
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| 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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