Introduction
Materials and Methods
Search Strategy
Search terms |
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Arab* OR “Arabic speaking” OR “Middle east*” OR Gulf |
migra* OR immigra* OR refugee* OR vulnerable OR minorit* OR emigra* OR “asylum seek*” |
Type 2 Diabetes OR Diabetes Type 2 OR type II diabetes OR Non- insulin Dependent Diabetes OR diabetes Mellitus |
1 AND 2 AND 3 |
Eligibility Criteria
Inclusion
Exclusion
Data Extraction
First Author, Pub.Year. | Study Settings/population/duration/sample size | Study’s Aim | Study design/tools used | Findings |
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Alzubaidi et al., 2015 | Many health care settings including diabetes outpatient clinics in two tertiary referral hospitals, six primary care practices and ten community centres. | A comparison between Arabic-speaking and English-speaking patients with type 2 diabetes regarding the experience of using medications and associated issues | Total participants N = 100 Arabic speaking n = 60 English-speaking n = 40 face-to-face semi structured individual interviews and group interviews. The questions were related to medicine taking behaviours and this include: Knowledge, views and communication with health care providers about medicine. | 1- Arabic-speaking individuals (ASB) often neglect to take medication due to their skepticism towards Western medicine. Furthermore, they tend to deliberately postpone seeking medical care when signs of diabetes appear. 2- There exists a belief among ASBs that enduring illness brings them closer to God. 3- ASBs expressed dissatisfaction about the lack of sustained dialogue with healthcare professionals. Instead, they lean significantly on relatives and friends for guidance concerning their prescribed therapies. 4- The Arabic-speaking community tends to have a negative perception of diabetes, viewing it as a social stigma. They believe that individuals with diabetes no longer fully integrate within their society. |
Bertran et al., 2015 | Self-identified Arab or Arab American 18 years and above with diagnosis of diabetes. Communities and pharmacies in Michigan N = 23 | Understand the barriers and facilitators of diabetes self-management education (DSME) among Arab Americans. | 3 Focus groups sessions used with questions aimed to explore the perceptions on DSM. | Cultural views on gender roles reveal inappropriateness of the female participants participation in mixed-gender exercise programs. Female participants expressed satisfaction with the physician’s non-interactive and directive style of interaction. Participants participation during the Ramadan, a cultural tradition, could supersede the advice of the provider and can impact the DSME The major barriers for DSME are the lack of available educational and support resources. Physician’s interaction style and comprehensiveness of care were the two most important features influencing participants’ views of patient-provider interactions. |
Alzubaidi et al., 2015 | Recruitment occurred at diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres | To explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia | Total participants N = 100 Arabic speaking n = 60 English-speaking n = 40 face-to-face semi structured individual interviews and group interviews. Duration of interviews ranged between 30 and 110 min The questions were related to who ASB approached when symptoms of diabetes developed, when and how they made a decision to access and use healthcare services, what are some associated barriers and enablers, perceptions about healthcare professionals, and knowledge of available diabetes healthcare services | 1- English-speaking individuals typically consult a general practitioner within days or weeks of noticing symptoms, whereas Arabic-speaking individuals usually delay such visits for months. 2- Compared to their English-speaking counterparts, Arabic-speaking immigrants have demonstrated less awareness of the non-medical services currently accessible for diabetes management. 3- The strong belief held by Arabic-speaking persons, encompassing ideas like “human life is ephemeral” and the notion that seeking medical aid is futile as death is inevitable, impacts their health behaviors. Additionally, they perceive enduring illnesses such as diabetes as a sign of proximity to God (Allah) and a path to absolution of sins. Consequently, their motivation to participate in self-management of diabetes is diminished. |
Fitz et al., 2016 | Health care facilities in Dearborn, Michigan | Measuring perspectives of the meaning of diabetes self-management and its culture related barriers and facilitators amongst Arab American providers and patients | Five focus groups Two sessions involved n = 8 Arab American healthcare practitioners. Three sessions were conducted with n = 23 Arab American patients with T2D. | 1- Individuals with diabetes have disclosed that their main obstacle to Diabetes Self-Management (DSM) is the absence of structured Diabetes Self-Management Education (DSME) programs. 2- Those suffering from Type 2 Diabetes (T2D) expressed that they do not experience stigma due to their condition. 3- Participants conveyed that DSM is challenging due to the stress they encounter, which they often attribute to familial circumstances. |
Alzubaidi et al., 2016 | Recruitment occurred at diabetes outpatient clinics in two tertiary referral hospitals, three primary care practices and two community centres. | To explore a new model for diabetes self-management support amongst Arabic-speaking immigrants in Australia. | Recruitment occurred at diabetes outpatient clinics in two tertiary referral hospitals, three primary care practices and two community centres. Total participants N = 60 N = 14 face-to face individual semi-structured interviews N = 8 group interviews involving 46 participants. | 1- Participants conveyed that living with diabetes signifies a lifetime affliction and a significantly reduced quality of life. They indicated receiving information about self-management only upon diagnosis. This lack of comprehensive knowledge renders Arabic-speaking individuals less confident in their ability to control their diabetes. 2- Participants expressed feeling unsupported, stressed, and anxious. They expressed concerns that emotional distress related to diabetes is not sufficiently addressed during medical consultations. They appealed for increased emotional support and better education to handle daily stress levels. They also sought guidance on diabetes-friendly food options and appropriate daily portion sizes. Participants demonstrated a preference for in-person interaction and sharing of experiences over phone counselling or online-based interventions. Furthermore, they showed a preference for an Arabic-speaking physician or diabetes nurse educator to guide them in self-management, not only for language comprehension but also for cultural context understanding. |
First Author, Pub.Year. | Study Settings/ population/ duration/sample size | Study’s Aim | Study design/ tools used | Findings |
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Jansà,* et al., 2009 | 10 primary healthcare centers in Barcelona, Catalonia, Spain | To determine the profile of Moroccans with type 2 diabetes mellitus (T2DM), to provide diabetes education strategies. | cross-sectional study 70 questions covering: social demographic profile (11 questions); clinical data (16 questions); daily living with diabetes (attributions, knowledge about diabetes and quality-of-life, 25 questions); sociocultural factors 14 questions); appointment compliance and use of alternative medicine (4 questions) | • Interviews were conducted with forty patients, having an average age of 50 ± 15 years, with 73% being females. The predominant languages spoken were Arabic (58%) and Berber (42%). A majority of patients (90%) resided with their families, and 67% had spent more than five years in Catalonia. A significant percentage of patients (53%) were unable to read or write, 11% were on insulin therapy, 12% were administered oral medications, and 60% possessed capillary blood glucose meters. 1- It was reported by 66% of the patients that they had difficulties adhering to their dietary guidelines, while 44% found it challenging to maintain their medication schedules. 2- In terms of self-reported causes of Type 2 Diabetes Mellitus (T2DM), views on potential cures for diabetes, adherence to medication and appointments, and the use of alternative medicine: 60% of patients experienced language barriers. Furthermore, 63% of patients indicated that their impediments were related to observing Ramadan, and 86% participated in the Feast of the Lamb. 3- Among the patients, 11% were taking oral medications and 12% were on insulin, in contrast to the native population where these figures were higher, at 70.2% and 21.4% respectively. Additionally, 24% turned to alternative treatments, often herbal remedies. |
Alzubaidi et al., 2015 | Diabetes outpatient clinics at three major hospitals, ten general medical practices, and five community support groups. | To compare illness and treatment perceptions between ASB and ENG people with T2D. Also, exploring the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in ASB and ENG patients with diabetes in Australia | A cross-sectional study used 12 validated tools measuring: diabetes-related distress, functional health literacy, treatment decision making, patients’ satisfaction with healthcare decisions, self-efficacy, and adherence to traditional values and attitudes (acculturation levels) | A high percentage of Arabic-speaking individuals (84%) exhibited low functional health literacy. Moreover, non-adherence to medication was seen in 88.3% of ASBs. A suboptimal level of blood sugar control and blood pressure was observed in 58.8% of ASBs, with HbA1c exceeding 7% (> 53 mmol/mol) and 13.85% having a blood pressure higher than 140/90mmHg. Additionally, Oral Hypoglycemic Agents (OHAs) were prescribed to 91.5% of the individuals. Compared to English-speaking participants, those who speak Arabic were significantly less compliant with all components of diabetes self-care, including dietary practices (P < 0.01; 95% confidence interval (CI) = − 1.17, − 0.84), physical activity (P = < 0.001, 95% CI = − 1.14, − 0.61), blood glucose testing (P < 0.001), and foot care (P < 0.001). Negative perceptions about diabetes among ASBs showed a strong and significant correlation with worse adherence to recommendations for diet, exercise, blood glucose testing, and foot care. Personal identity perceptions were significantly related to poor adherence to exercise, blood glucose testing, foot care, and dietary habits (Spearman’s rank correlation coefficients – 0.503; – 0.481– 0.228, – 0.494; respectively; P values < 0.001). 4- ASBs were less inclined to acknowledge the necessity for diabetes medications compared to English-speaking participants (P < 0.001, 95% CI = 0.93, 0.68). They also demonstrated heightened concerns regarding the usage and effects of diabetes medications (mean ± SD, 2.60 ± 0.86). |
Alzubaidi et al., 2017 | Diabetes outpatient clinics at three major hospitals, ten general medical practices, and five community support groups. | To examine and compare the patient–pharmacist relationship, medication underuse and adherence levels among Arabic speaking and Caucasian English-speaking patients with type 2 diabetes. | A cross-sectional study used 12 validated tools measuring: diabetes-related distress, functional health literacy, treatment decision making, patients’ satisfaction with healthcare decisions, self-efficacy, and adherence to traditional values and attitudes (acculturation levels) | Arabic-speaking individuals (ASBs) have been reported to have a lower compliance rate with pharmacist recommendations when compared to English-speaking individuals (ESBs), with 32% and 61.9% compliance rates respectively. ASBs were less prone to engage in conversations about their prescribed treatments with community pharmacists compared to ESBs, with the rates being 36% and 29% respectively. 3- Individuals holding a high school degree were almost twice as likely to seek a pharmacist’s advice concerning treatment or health issues, compared to those without a high school degree. |
Berlie, et al., 2007 | Cross sectional, population-based study conducted in Arab Americans during the years 2000 and 2001, In Dearborn, Michigan | To evaluate the quality of care among Arabic-speaking living with diabetes in United states. Also, comparing the results with other ethnic groups. | Cross sectional, population-based study conducted in Arab Americans during the years 2000 and 2001, assess the quality of care received by Arab American patients, Quality indicators (QI) such as the distribution of HbA1c, LDL, SBP and DBP were used to gauge the level of care received by the study patients. On the other hand, accountability measures were used to compare the quality of care in the Arab American population to that of the United States population | Over the past year, Arab Americans with diabetes reported visiting their physician once, with 75% of them stating they had four or more appointments. Merely 30% of the respondents achieved the American Diabetes Association (ADA) recommended HbA1c target of less than 7%. An average of 1.1 + 0.3 blood glucose tests per day and 4.6 + 3.8 tests per week were reported by 74% of participants. 66% of participants indicated that they had received diabetes education. Nutritional guidance was received by 93% of respondents, with 89% stating they adhered to the provided instructions. Strenuous exercise was partaken in by only 15% of Arab Americans, with a mere 5% engaging in non-strenuous physical activities. 70% of participants had an HbA1c of 7% or higher, and 25% had an HbA1c of 10% or higher. A greater proportion of female participants, 78%, had an HbA1c of 7% or higher, compared to 57% of males. A higher rate of non-completion of high school was noted among Arab Americans compared to other ethnic groups (41.5% NHANES vs. 27.1% BRFSS vs. 81.6% Arab American). Poor glycemic control, defined as HbA1c exceeding 9.5%, was comparable between Arab American females and the national female sample (21.9% vs. 20.3%), while Arab American males were more prone to poor glycemic control than the national male sample (33.3% vs. 16.1%). Arab American patients who hadn’t completed high school displayed higher rates of poor glycemic control compared to the national sample without a high school degree (30.0% vs. 16.1%). In the Arab American population, having diabetes for 15 years or more was associated with higher rates of poor glycemic control compared to the national sample (40.0% vs. 14.5%) . The likelihood of perceiving regular exercise as a crucial part of diabetes self-management was 70% lower for unemployed individuals compared to those who were employed [(Unemployed OR = 0.30, P = 0.046; 95% CI = 0.093–0.980)]. A significant relationship was observed between receiving instructions in Arabic and the outcome of food selection [OR = 6.66, P = 0.014; 95% CI = 1.48–30.03)]. A strong correlation was found between receiving instructions in Arabic and maintaining a healthy lifestyle [OR = 43.98, P = 0.003; 95% CI = 3.75-515.24)]. A considerable link was noted between family encouragement and engagement in discussions with clinicians regarding care [OR = 71.35, P = 0.003; 95% CI = 4.28-1189.06)]. There was a significant correlation between family understanding of food choices and participation in regular exercise [OR = 2.41, P = 0.03; 95% CI = 1.09–5.35)]. Participants voiced their concerns about dialogues with health-care providers and expressed a wish for doctors to provide more information and assistance regarding diabetes management. Participants also stressed the need to concentrate on the younger generations and educate them about a healthy lifestyle to foster a healthier community. |
El Masri, 2020 | To assess perceptions of diabetes self-management behaviors among ASBs with diabetes living in the US. | community pharmacies located in Michigan | For Quantitative analysis - Measure of central tendency were used to describe the sample - Pearson Chi-square tests were used to determine associations between perceptions of DSM behaviors and practices. - Logistic regression was also used to control for demographic factors and to obtain odds ratios between covariates and outcomes associated with perceived importance of DSM. behaviors. For Qualitative analysis: - data-driven inductive approach was used to establish codes and common themes. | Homemakers were 82% less likely to perceive regular exercise as an important DSM behavior. [(homemakers: OR = 0.187, P = 0.006; 95% CI = 056-0.620), The likelihood of perceiving regular exercise as a crucial part of diabetes self-management was 70% lower for unemployed individuals compared to those who were employed [(Unemployed OR = 0.30, P = 0.046; 95% CI = 0.093–0.980)]. A significant relationship was observed between receiving instructions in Arabic and the outcome of food selection [OR = 6.66, P = 0.014; 95% CI = 1.48–30.03)]. A strong correlation was found between receiving instructions in Arabic and maintaining a healthy lifestyle [OR = 43.98, P = 0.003; 95% CI = 3.75-515.24)]. A considerable link was noted between family encouragement and engagement in discussions with clinicians regarding care [OR = 71.35, P = 0.003; 95% CI = 4.28-1189.06)]. There was a significant correlation between family understanding of food choices and participation in regular exercise [OR = 2.41, P = 0.03; 95% CI = 1.09–5.35)]. Participants voiced their concerns about dialogues with health-care providers and expressed a wish for doctors to provide more information and assistance regarding diabetes management. Participants also stressed the need to concentrate on the younger generations and educate them about a healthy lifestyle to foster a healthier community. |