Background
Method
Study | Theme/category | Data extract (first order construct) | Data extract (second order construct) | Conclusion (synthesis) |
---|---|---|---|---|
Lawton et al., 2005 [21] | Adjusting of drugs/symptoms severity | “....And now in the morning I take three pills, sometimes two, meaning I check it (blood glucose) and according to that I do or don’t take all the pills”. | Popular ideas about medicines, derived from the Indian subcontinent, may have informed the ways respondents perceive and take their oral hypoglycaemic agents (OHAs). On the Indian subcontinent, people commonly self-medicate, make selective use of prescribed drugs, and abandon drugs that do not provide prompt relief of symptoms. This might explain why some respondents adjusted their OHAs without seeking medical approval and according to the presence or absence of symptoms. | Symptom control significantly influenced adherence to treatment. Patients’ health beliefs and medication adherence may be affected by the severity of disease. Patients make critical decisions that affect the therapeutic outcome of their disease. Patients’ beliefs about disease and medications may be crucial to their intentional adherence behaviours and may be very different to those of the health professional. |
Lawton et al., 2006 [22] | God/fatalistic view | “....God has given me these diseases, and they will never go away, you just get more and you cannot do much about it”. | Whilst fatalism has been attributed to belief in God’s will, which is a strong feature of the Muslim, Hindu and Sikh religions our findings suggest that call/recall systems may reinforce patients’ perceptions that they are not responsible for disease self-management, when they have migrated from a country where they are expected to seek out medical care. | Generally south Asian patients were more likely than their European counterparts to contextualise their diseases in relation to their religion beliefs. This often resulted in lack of motivation to improve their disease. |
Search terms
Data extraction
Results
References | Aim of the paper | Country | Sample characteristics | Quality method and analysis used | Quality check |
---|---|---|---|---|---|
[1] Number | |||||
[2] Disease | |||||
[3] M/F | |||||
Bissell et al., 2004 [18] | To explore barriers to accomplish a re-framed model of health care in English- speaking patients of Pakistani origin with type 2 diabetes. | UK | [1] Twenty one patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently reviewed by research team. |
[2] Patients diagnosed with diabetes | |||||
[3] Gender not reported | |||||
Fagerli et al., 2005 [36] | To explore how ethnic minority persons with diabetes experience dietary advice given by Norwegian health workers. | Norway | [1] Fifteen patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified by interpreters. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 4/F = 11 | |||||
Fleming et al., 2008 [38] | To explore the influence of culture on type 2 diabetes self-management in Gujarati Muslim men. | Canada | [1] Five patients | Case study approach. Analysis using theory building and fieldwork. | None reported. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 5 | |||||
Galdas et al., 2010 [33] | To explore the cardiac rehabilitation experiences of Punjabi Sikh patients post myocardial infarction. | Canada | [1] Fifteen patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently reviewed by research team. |
[2] Patients diagnosed with CVD | |||||
[3] M = 10/F = 5 | |||||
Keval et al., 2009 [19] | To explore South Asian Hindu Guajarati speaking people’s experience of type 2 diabetes. | UK | [1] Eighteen patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently reviewed by research team. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 10/F = 8 | |||||
King et al., 2006 [34] | To explore the influence of gender on managing coronary artery disease. | Canada | [1] Eighteen patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified by interpreters. |
[2] Patients diagnosed with CVD | |||||
[3] M = 10/F = 8 | |||||
Lawton et al., 2005 [20] | To explore British Pakistani and British Indian patients’ perceptions and experiences of taking oral hypoglycaemic agents. | UK | [1] Thirty two patients (fifteen South Asian) | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently reviewed by authors. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 4/F = 11 | |||||
Lawton et al., 2005 [21] | To explore Pakistani and Indian patients’ experiences of, and views about, diabetes services. | UK | [1] Thirty two patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified by research team in addition software for qualitative data analysis was used. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 15/F = 17 | |||||
Lawton et al., 2006 [22] | To explore patients’ perceptions and experiences of under-taking physical activity amongst people of Pakistani and Indian origin with type 2 diabetes. | UK | [1] Thirty two patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified by research team and interpreters. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 17/F = 15 | |||||
Lawton et al., 2007 [23] | To explore patients’ perceptions and understanding of disease causation. | UK | [1] Thirty two patients (fifteen South Asian) | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts independently were verified by authors. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 4/F = 11 | |||||
Lewis 2007 [24] | To examine the lived experience and cultural illness explanations of a sample of British Indian diabetic patients living with leg and foot ulcers. | UK | [1] Sixteen patients | In-depth semi-structured interviews, analysis using Greens’ Framework used to code data. (framework not explained). | None reported. |
[2] Patients diagnosed with diabetes | |||||
[3] Gender not reported | |||||
Meetoo 2004 [25] | To examine the dietary pattern of self-care for a group of Asian and Caucasian diabetes patients. | UK | [1] Twenty five patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently reviewed by research team. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 8/F = 17 | |||||
Meetoo 2005 [26] | To explore the Explanatory models of diabetes by a group of Asian and Caucasian patients. | UK | [1] Twenty five patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently reviewed by research team. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 8/F = 17 | |||||
Oliffe et al., 2010 [35] | To describe the connections between masculinities and diet among senior Punjabi Sikh Canadian immigrant men. | Canada | [1] Eighteen patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were verified by interpreters and NVivo software was used. |
[2] Patients diagnosed with CVD | |||||
[3] M = 18 | |||||
Rafique et al., 2006 [37] | To assess the needs, awareness and barriers to diabetes education or self-management in diabetic patients. | Pakistan | [1] Twenty seven patients | In-depth semi-structured interviews, analysis using grounded theory. | None reported. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 11/F = 16 | |||||
Rhodes et al., 2003 [27] | To examine the experience of diabetes and local services in Bangladeshi diabetic patients. | Canada | [1] Eighteen patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified between authors. Member checking was undertaken with authors checking codes. |
[2] Patients diagnosed with diabetes | |||||
[3] Gender not reported | |||||
Rhodes et al., 2003 [28] | To examine access from the point of view of Bangladeshi diabetic patients. | UK | [1] Twelve patients | In-depth semi-structured interviews, analysis using text detective software package. | None reported. |
[2] Patients diagnosed with diabetes | |||||
Singh et al., 2012 [29] | To explore experiences of UK based South Asian and White patients with diabetes. | UK | [1] Twelve patients | In-depth semi-structured interviews, analysis using phenomenology | Transcripts were independently verified by authors. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 6/F = 6 | |||||
Stack et al., 2008 [30] | To explore perceptions towards multiple medicines expressed by people managing co-morbidities. | UK | [1] Three patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified by authors. |
[2] Patients diagnosed with diabetes & CVD | |||||
[3] Gender not reported | |||||
Stone et al., 2005 [31] | To explore the experience and attitudes of primary care patients with diabetes living in UK. | UK | [1] Fifteen patients | In depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified between two researchers. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 6/F = 9 | |||||
Wilkinson et al., 2012 [32] | To explore renal complications of diabetes from the patients’ perspective. | UK | [1] Twenty five patients | In-depth semi-structured interviews, analysis using grounded theory. | Transcripts were independently verified between authors. NVivo software used to code data. |
[2] Patients diagnosed with diabetes | |||||
[3] M = 16/F = 9 |
Beliefs about the need for and efficacy of medicines
[Quote 1]“If I didn’t take them then I would be in danger.” Male of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 2]“Once you start on these then you have to be on them for the rest of your life. So either you do that, or you risk dying. So you have no choice but to take the medicine.” Female of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 3]“My health depends on these and I am continuing to take my medications now.” Female of Indian origin diagnosed with CVD: Canada Study [33]. |
[Quote 4]“I don’t think you can get the same kinds of medicine that you can get here, you know, like metformin. This is one of the most important drugs to take for it.” Female of Indian origin diagnosed with diabetes: UK study [20]. |
[Quote 5]“See, in Pakistan, the medications are not right, they’re just a waste of time, waste of money. I mean these [referring to hypoglycaemic agents] are the real stuff. These are what really work.” Male of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 6]“At the moment I’m eating ‘Methi’ [fenugreek] because I believe in Ayurvedic medicine. But I’m also very pro-western medicine as well – it’s a question of trial and error.” (gender not stated) South Asian of Indian origin diagnosed with diabetes: UK study [19]. |
[Quote 7] “Sometimes you do say that to yourself, you know, you say to yourself, ‘Oh I feel fine and I’ll take one today, I won’t take two.” Female of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 8]“I don’t take my tablets on many times [laughs].” Male of Pakistani origin diagnosed with diabetes: UK Study [20]. |
[Quote 9]“They said that I need to take three, but for the last three months I’m just taking them twice a day. It’s just when I feel I’m tired I take another one. If I’m fine then I won’t.” Male of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 10] “I don’t find any difference but because they say that my cholesterol level is slightly higher that it should have been – I think if I don’t take I, I don’t find any difference” Male of South Asian origin diagnosed with CVD: UK Study [30]. |
[Quote 11]“Sometimes I will take two when I don’t spread too much jam on my toast or even sometimes I don’t even spread any. If I feel like a bit of a pleasure then I will put some on and then I will take the extra tablets.” Male of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 12]“I never comply with my treatments at weddings and parties....” Female of Indian origin diagnosed with diabetes: UK study [25]. |
[Quote13] “I visit families and friends a lot of the time. I don’t comply especially when I go to weddings and when I visit friends and relatives. At other time I don’t always comply with treatment within my own house.” Female of Indian origin diagnosed with diabetes: UK study [26]. |
[Quote 14]“My father also had diabetes. He used to be very adherent [to diet and medication]. But despite this he died of a stroke. Since then, I have become non-adherent. I think, what is the point?.” Male of Pakistani origin diagnosed with diabetes: UK study [37]. |
[Quote 15]“Last time I went to Pakistan, I went for ten months and I brought with me my blood-sugar monitor and two kinds of tablets. The first five months I used the medications, but not the last five. That’s because I went hunting every second day and walked for 15 to 20 km. In the evenings when I checked, my blood sugar was ok, and I didn’t have to use the tablets.” (Gender not stated) patient of Pakistani origin diagnosed with diabetes: Norway study [36]. |
Toxicity of medicines and polypharmacy
[Quote 16]“Initially it was just two metformins a day, and then it was increased to four by the doctor. And then there’s blood pressure tablets to take and then aspirins and so on. So it all adds up and, you know, if you take seven, eight pills a day and you wonder [laugh] is it the right thing? This can’t be good for me in the long run these can be poisons.” Male of Indian origin diagnosed with diabetes: UK study [20]. |
[Quote 17]“… like the thought of something going wrong with my kidneys, like something going wrong with your lungs or your heart, it’s scary. So I think I would have - I probably wouldn’t even be on insulin now.” (Gender not stated) South Asian of Indian origin diagnosed with diabetes: UK Study [32]. |
[Quote 18]“Yes, they told me to take it every day, but I said ‘do I want to die by taking it every day…I don’t want to die by taking so many.” Female of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 19]“Already I am dull, my body is, by taking so many tablets.” Female of Pakistani origin diagnosed with diabetes: UK study [20]. |
[Quote 20]“Sometimes I don’t take them, you know, they make you dry if you take too many.” Female of Pakistani origin diagnosed with diabetes: UK Study [20]. |
[Quote 21]“For my asthma, they gave me tablets and they were sweet tablets [steroids], and I had to take eight tablets all at once…I stayed [in hospital] for a week and they gave me all those tablets, and because of that I got sugar…I was angry that I got sugar because of their medication.” Female of Indian origin diagnosed with diabetes: UK study [23]. |
Stigma and social support
[Quote 22]“When I am back in Pakistan they (family) don’t let me tell anybody that I have it, which makes it very difficult for me when I go out. If I am going around somebody’s house for a meal, they make me do the injection before I go. I can sit there and they won’t have their meal ready till two hours later and I will just have to keep popping myself with coke…” (gender not stated) Patient of Pakistani origin diagnosed with diabetes: UK study [29]. |
[Quote 23]“I got a shock when they put me on insulin … I asked doctors to give me two weeks to decide whether I want to start taking insulin or not, it is not difficult in the personal sense … it is more because of our culture and community. People look at you and go, ‘Oh God! Is he taking insulin?’ … people feel that you have a very dangerous kind of disease …it is really embarrassing.” (gender not stated) South Asian of Indian origin diagnosed with diabetes: UK study [29]. |
[Quote 24]“In our culture you’re not wanting to know that you‘ve got any kind of disease like diabetes which is why we don’t want the injections.” Male of Pakistani origin diagnosed with diabetes: UK study [22]. |
[Quote 26]“I feel there is no life without wife. After a certain age there is a desperate need for a partner… they will remind you and say, ‘have you taken your insulin?’ or ‘take your insulin and in the mean time I will prepare food for you and lay it on the table’… this way, together you can look after diabetes better.” (gender not stated) Patient of Pakistani origin diagnosed with diabetes: UK study [29]. |
[Quote 27]“My daughter is a nurse. I learned a lot from my daughter. At first, she used to do all the monitoring and injecting and things, but now I can do them myself.” Male of Pakistani origin diagnosed with diabetes: Pakistan study [37]. |
The necessity of traditional remedies versus Western medicines
[Quote 28]“There are some things like ginger and garlic that we use. These two things are good for a man’s health. The more you use it the better it is. They reduce cholesterol, it makes a difference to heart attack too.” Male Immigrant of Indian origin diagnosed with diabetes: Canada study [35]. |
[Quote 29]“I always check my levels, and then take my tablets, and if I need to I’ll have some chocolate or something. I’ll also take some ‘kurvat ni phaki’ [bitter powder] … this makes quite a difference to me. This is from Dubai … whatever happens I always take my medication … I use ‘karela’ [bitter gourd] as well.” Female of Indian origin diagnosed with diabetes: UK Study [19]. |
[Quote 30]“It’s fine, there’s no side-effects, it’s all herbal … there should be more information about these things. We also use Neem [Azadirachta Indica] powder, which we used to use for malaria in India, we got this from here. We alternate these remedies, to balance the different things.” Male of Indian origin diagnosed with diabetes: UK Study [19]. |
[Quote 31]“It’s green medicine. It’s natural medicines and it has a reputation for maybe tackling conditions that western medicines are not so used to.” (gender not stated) Patient of Indian origin diagnosed with diabetes: UK Study [24]. |
[Quote 32]“First I take a quarter spoon of turmeric in warm water, then I use Meth [fenugreek], and then I take ammo [again], which reduces the amount of gas we get … turmeric is an antibiotic, oftentimes diabetics get this and that, and I still don’t have any infections from where I have been hurt.” Female of Indian origin diagnosed with diabetes: UK study [19]. |
[Quote 33]“There was an article … in a newspaper which we get from India, and my niece sent the Jambu [rose apple] powder from India…but you can get this information from Gujarati newspapers here as well. ‘Karela’ [bitter gourd] we also use, both as a curry and tablets.” Male of Indian origin diagnosed with diabetes: UK study [19]. |
[Quote 34]“Well, we’re from India, so my mother and others used them. My brother was always using these medicines … he used to write to me with advice and send them to me.” Female of Indian origin diagnosed with diabetes: UK study [19]. |
[Quote 35]“I used to take juice of bitter gourd for sugar [diabetes] problems….Now I have stopped that. I have been given a tablet by the doctor and eat that once a day.” Male Immigrant of Indian origin diagnosed with diabetes: Canada study [19]. |
[Quote 36]“Homeopathy in India is very big and homeopaths are everywhere. A lot of people go to them and don’t go to a doctor. My wife said to me you should go to a homeopath but actually I don’t believe in that,. I believe in medicines.” (gender not stated) South Asian of Indian origin diagnosed with diabetes: UK study [19]. |
Communication
[Quote 37] Daughter: “They have done it only recently. My mother had an appointment in September, but I could not go with her because I had personal problems from the surgery, they never bothered to chase that appointment from September to January. I myself took my mother to the surgery, that when they found my mother HbA1c reading was 12.9. The tablets my mother was taking, she was supposed to take one tablet daily, but she was taking the same tablet twice, which she should not have done.” South Asian of Indian origin diagnosed with diabetes: UK study [27]. |
[Quote 38]“One thing is, if you were having a side effect from your medicine, you could discuss it with your doctor, or the nurse. Yes, yes, I see. But this has happened and I talk with doctor about it. And he tell me it will pass and it did. PB. So you can already do that? Oh yes, if want to ask questions, then I do already. I can do that with doctor. He say we can do that.” (gender not stated) South Asian of Indian origin diagnosed with diabetes: UK study [18]. |
[Quote 39]“I’ve seen it happen. They’ll be waiting to ask questions about their medicines or what have you and then not feel like they can when they get in there. I’ve felt like that myself, haven’t you? It’s like you don’t think you can ask any questions when you get in the room with the doctor.”(gender not stated) South Asian of Indian origin diagnosed with diabetes: UK study [18]. |
[Quote 40]“The doctor had then taken lots of tests and he gave the medicines. He didn’t say anything in particular about how to take care of my heart he just gave the medicines.” (gender not stated) Sikh Immigrant of Indian origin diagnosed with CVD: Canada study [34]. |
[Quote 41]“We take tablets, but how are we supposed to know if it’s in control or not? I’ve got this stick thing to measure it with and I have also got this machine and with that you know what it is, whether it is 7.5 or 8.5 or whatever.” Male of Pakistani origin diagnosed with diabetes: UK Study [31]. |
[Quote 42]“He was giving me medication but wasn’t asking me for any urine sample or anything.” Female of Pakistani origin diagnosed with diabetes: UK study [28]. |
[Quote 43]“It depends how rich you are, how much money you’ve got for the medication......they would go to the doctor but paying for the medication or being told you will have this and you’ve got to pay this much every month for a tablet, it’s highly unlikely that they’re going to stick to that regimen.” Male of Pakistani origin diagnosed with diabetes: UK study [38]. |
[Quote 44]“The poor over there (Pakistan) die, because they can get no treatment. Doctors’ pockets over there are so big, they’re full of notes.” Female of Pakistani origin diagnosed with diabetes: UK study [21]. |
[Quote 45]“You know how it is there, our doctors don’t really pay attention. They are more concerned with the amount of money they are making. First they will give you a lighter medication, which will make you go back to them again and again until they give you something else. And by that time, you will be feeling better anyway.” Male of Pakistani origin diagnosed with diabetes: UK Study [20]. |