Baradaran Hamid R, Knill-Jones Robin P, Wallia Sunita, Rodgers Alison
Medical Education & Development Centre, Iran University of Medical Sciences, Tehran, 14496, Iran.
BMC Public Health. 2006 May 18;6:134. doi: 10.1186/1471-2458-6-134.
Epidemiologic data have shown that the prevalence of Type 2 diabetes varies with ethnic origin. Type 2 diabetes is up to four times more common in British South Asians than in the indigenous white population. The aim of this study was to develop a culturally appropriate educational intervention programme for South Asians with Type 2 diabetes. We then investigated whether this intervention could produce an improvement, and finally whether any improvement was greater than background changes in knowledge in comparison groups.
A multi-site prospective, randomised controlled study was conducted in all day care centres and three general practice registers with high proportion patients from different ethnic minority groups in Glasgow, Scotland. The intervention consisted of 18 educational sessions in 6 separate programmes. A modified questionnaire was used to measure the knowledge, attitudes, and practice of diabetes before and after intervention.
Baseline assessment showed that Indian and Pakistani subjects had less knowledge about diabetes, regarded the disease less seriously, and had a lesser understanding of the relationship between control and complications than the white population. No differences in initial responses were found between those who completed the second assessment and those who did not. The intervention group showed significant improvements in scores for Knowledge (+12.5%); Attitudes toward seriousness (+13.5%), complications (+8.1%), Practice (+20.0%). However there were also changes in the ethnic control group scores; respectively +5.0%, +16.3% (significant P < 0.001), +1.5%, +1.7%. The single white control group also showed some improvements; respectively +12.2%, +12.4% (P = 0.04), +6.0%, +25.0% (P = 0.007), but the differences in improvement between these two control groups were not significant. Overall, the improvement seen was similar in both intervention and ethnic control groups and there was no significant difference in the amount of change (P = 0.36 CI -0.9 to +2.6).
This study has shown that conducting a culturally-competent educational intervention in patients with Type 2 diabetes from ethnic minority groups is feasible and can improve their knowledge and attitudes and practice. However there was no net benefit compared with the control group.
流行病学数据显示，2型糖尿病的患病率因种族不同而有所差异。英国南亚裔人群中2型糖尿病的发病率比本土白人群体高出四倍。本研究的目的是为患有2型糖尿病的南亚裔人群制定一个符合其文化背景的教育干预项目。我们随后调查了该干预措施是否能带来改善，最后探究与对照组相比，任何改善是否大于知识方面的背景变化。
在苏格兰格拉斯哥的所有日间护理中心以及三个拥有高比例不同少数族裔患者的全科医疗登记处进行了一项多中心前瞻性随机对照研究。干预措施包括在6个独立项目中开展18次教育课程。使用一份经过修改的问卷来测量干预前后糖尿病相关的知识、态度和行为。
基线评估表明，印度裔和巴基斯坦裔受试者对糖尿病的了解较少，对该疾病的重视程度较低，并且对控制与并发症之间关系的理解不如白人群体。完成第二次评估的人与未完成的人在初始反应上未发现差异。干预组在知识得分（提高12.5%）、对严重性的态度（提高13.5%）、并发症（提高8.1%）、行为（提高20.0%）方面有显著改善。然而，种族对照组的得分也有变化；分别为提高5.0%、16.3%（P<0.001，显著）、1.5%、1.7%。单一的白人对照组也有一些改善；分别为提高12.2%、12.4%（P = 0.04）、6.0%、25.0%（P = 0.007），但这两个对照组在改善程度上的差异不显著。总体而言，干预组和种族对照组的改善情况相似，变化量没有显著差异（P = 0.36，置信区间-0.9至+2.6）。
本研究表明，对少数族裔2型糖尿病患者进行具有文化胜任力的教育干预是可行的，并且可以改善他们的知识、态度和行为。然而，与对照组相比没有净效益。
