Exploring culturally competent primary care diabetes services: a single-city survey

AIMS

To determine the cultural competence of diabetes services delivered to minority ethnic groups in a multicultural UK city with a diabetes prevalence of 4.3%.

METHODS

A semi-structured survey comprising 35 questions was carried out across all 66 general practices in Coventry between November 2011 and January 2012. Data were analysed using descriptive statistics. The cultural competence of diabetes services reported in the survey was assessed using a culturally competent assessment tool (CCAT).

RESULTS

Thirty-four general practices (52%) responded and six important findings emerged across those practices. (1) Ninety-four per cent of general practices reported the ethnicity of their populations. (2) One in three people with diabetes was from a minority ethnic group. (3) Nine (26.5%) practices reported a diabetes prevalence of between 55% and 96% in minority ethnic groups. (4) The cultural competences of diabetes services were assessed using CCAT; 56% of practices were found to be highly culturally competent and 26% were found to be moderately culturally competent. (5) Ten practices (29%) reported higher proportionate attendance at diabetes annual checks in the majority white British population compared with minority ethnic groups. (6) Cultural diversity in relation to language and strong cultural traditions around food were most commonly reported as barriers to culturally competent service delivery.

CONCLUSIONS

Seven of the eight cultural barriers identified in the global evidence were present in the city. Use of the CCAT to assess existing service provision and the good baseline recording of ethnicity provide a sound basis for commissioning culturally competent interventions in the future.

The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review

AIM

To examine the evidence on culturally competent interventions tailored to the needs of people with diabetes from ethnic minority groups.

METHODS

MEDLINE (NHS Evidence), CINAHL and reference lists of retrieved papers were searched from inception to September 2011; two National Health Service specialist libraries were also searched. Google, Cochrane and DARE databases were interrogated and experts consulted. Studies were included if they reported primary research on the impact of culturally competent interventions on outcome measures of any ethnic minority group with diabetes. Paper selection and appraisal were conducted independently by two reviewers. The heterogeneity of the studies required narrative analysis. A novel culturally competent assessment tool was used to systematically assess the cultural competency of each intervention.

RESULTS

Three hundred and twenty papers were retrieved and 11 included. Study designs varied with a diverse range of service providers. Of the interventions, 64% were found to be highly culturally competent (scoring 90-100%) and 36% moderately culturally competent (70-89%). Data were collected from 2616 participants on 22 patient-reported outcome measures. A consistent finding from 10 of the studies was that any structured intervention, tailored to ethnic minority groups by integrating elements of culture, language, religion and health literacy skills, produced a positive impact on a range of patient-important outcomes.

CONCLUSIONS

Benefits in using culturally competent interventions with ethnic minority groups with diabetes were identified. The majority of interventions described as culturally competent were confirmed as so, when assessed using the culturally competent assessment tool. Further good quality research is required to determine effectiveness and cost-effectiveness of culturally competent interventions to influence diabetes service commissioners.

Humic colloid mediated transport of tetravalent actinides and technetium

The humic colloid mediated transport of tetravalent actinide and technetium ions is discussed. Numerous published and new results are used from comparable experimental systems and conditions. The results originate from investigations on two humic rich Gorleben groundwater/sediment systems under near-natural conditions. The conditioning time between groundwater and radionuclides vary from few minutes to four years. The migration time (residence time in the column) is varied from four hours to three days. The concentration of radionuclides added is varied between about 10-12 and 10-4mol/L. Humic colloids in natural groundwater contain trace metal ions in varying concentrations. In addition to studying the behavior of radionuclides added to the groundwater in the laboratory, the dissociation behavior of these natural tetravalent trace metal ions is studied by scavenging dissociating ions with a cation exchanger. The results show a kinetic behavior of the trace metal ion interaction as frequently reported in the literature, i.e. with increasing contact time, slow dissociation modes are progressively populated resulting in an enhanced radionuclide transport. The strong dependency of the radionuclide transport on the radionuclide concentration shows that humic colloid mediated transport may be overestimated if radionuclide concentrations used in laboratory studies are too high. Dissociation of the natural inventory of humic associated tetravalent trace metal ions proceeds with a kinetics comparable to the radionuclides added. This, however, is only observed for a small portion of the inventory and extrapolation beyond the observation range is not permissible. Therefore, the key question for application to predictive modeling of the mobility of tetravalent radionuclides in natural groundwater is if the behavior of the natural trace element inventory is applicable or the behavior of radionuclides added in laboratory studies.