Understanding the self-management of type 2 diabetes in black and minority ethnic groups using a health literacy framework

Background: The aim of this thesis was to explore the self management of Type 2 diabetes mellitus (T2DM) in black and minority ethnic (BME) groups using health literacy (HL) as the conceptual framework. Study One: Study One was a multi-method systematic review that aimed to answer the research question: What is known about the barriers to, and facilitators of, self- management of T2DM amongst BME groups? There were two review strands. The interventions strand drew together quantitative evidence on T2DM self-management interventions in patients from 28 trials. Secondary analyses demonstrated that interventions were most likely to show a positive effect on self-management if they were culturally competent and based on a theoretical framework. The 'views' strand of the review synthesised 57 predominantly qualitative studies of participants' perspectives on diabetes self-management. Thematic synthesis identified 'Sense of self as the over-arching theme. Finally, a cross-synthesis of the findings from both review strands was undertaken so as to consider whether barriers and facilitators to effective self-management identified within participants' views had been addressed by available interventions. Study Two: Study Two was a qualitative interview study with 15 first and second generation immigrant, British-Pakistani women who had T2DM. The study aimed to address the research question: How does having T2DM affect patients' identity and how does this relate to subsequent self-management? Thematic analysis identified the over-arching theme, 'Role re-alignment enables successful self- management' . Health literacy: Studies One and Two had the same subsidiary aim which was: To refine Nutbeam's conceptual framework of HL (2000) in the context of T2DM Using the key findings of both studies, operational definitions were developed for the different levels. Functional HL reflected day-to-day adherence, interactive HL focused on soliciting information and critical HL emphasised acquiring knowledge from experience. A critique was also presented of the conceptual framework focusing on its hierarchical nature and broader applicability.