Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Vivene Grant, Ian Litchfield
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Abstract

Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities.The major databases were searched for existing qualitative evidence of participants’ experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon’s Theoretical Framework of Acceptability.The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants’ satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs.Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.
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针对 2 型糖尿病少数民族患者的社区保健员和同伴支持干预措施的可接受性:定性系统综述
在北美、欧洲和其他地区的高收入国家,少数民族群体受 T2DM 的影响尤为严重,死亡率和发病率也更高。我们在主要数据库中搜索了现有的定性证据,以了解在少数族裔人群中由社区卫生工作者和同伴支持者(CHWPs)提供 2 型糖尿病自我管理支持的参与者的经验和观点。为了清晰和简洁起见,我们将在可接受性框架的五个领域内对结果进行描述:情感态度描述了参与者对社区保健工作者提供干预措施的满意度,包括与临床提供者建立的开放、信任关系。在考虑负担和机会成本时,参与者反思了健康、交通、工作和育儿责任对他们参加活动的影响,以及缺乏保持健康饮食和积极生活方式所需的资源。在文化敏感性方面,参与者对 CHWPs 所表现出的特殊文化需求和挑战有了更深入的了解。与干预一致性相关的证据表明,学员们对实际应用内容、各种教材和互动实践课程反应积极。最后,在研究有效性和自我效能的影响时,参与者描述了他们如何改变了一系列与健康有关的行为,在处理病情和与资深临床医生互动时更有信心,并从其他参与者和社区保健工作者的社会支持中受益。然而,社区保健工作者的洞察力、他们对文化敏感的自我管理具体策略以及他们建立的信任关系都具有相当大的优势。
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