Sidhu Manbinder S, Gale Nicola K, Gill Paramjit, Marshall Tom, Jolly Kate
Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
BMC Health Serv Res. 2015 Feb 7;15:54. doi: 10.1186/s12913-015-0712-8.
Self-management education is at the forefront of addressing the increasing prevalence of chronic diseases. For those at greatest risk, such as minority-ethnic and/or socio-economically deprived groups, self-management education can be culturally-tailored to encourage behavioural change. Yet, the application of culturally appropriate material and expertise within health promotion services continues to be debated. We critique the design, implementation, and delivery of a culturally-tailored self-management intervention, with particular focus on the experiences of lay educators.
A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). We interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages.
Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator's cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness.
Lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the 'community' links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.
自我管理教育处于应对慢性病患病率不断上升问题的前沿。对于那些风险最高的人群，如少数族裔和/或社会经济贫困群体，自我管理教育可以进行文化定制以鼓励行为改变。然而，在健康促进服务中应用符合文化背景的材料和专业知识仍存在争议。我们对一项文化定制的自我管理干预措施的设计、实施和提供进行了批判，特别关注外行人教育者的经历。
进行了一项混合方法的定性评估，以了解向文化多元社区提供自我管理服务的情况（即外行人工作者、基于小组的设计和符合文化背景的教育材料等组成部分如何旨在鼓励行为改变）。我们采访了提供慢性病教育者项目的外行人教育者以及参与者，同时观察了研讨会。通过多个解释性分析阶段，使用基于内容的持续比较方法对数据进行了主题分析。
外行人教育者感觉自己是当地社区的一部分，与来自不同种族和民族的参与者建立了联系。然而，外行人教育者在解决健康观念和改变生活方式方面面临挑战。文化定制的组成部分有助于沟通，教育者的文化意识导致与参与者建立密切关系，而基于小组的设计促进了对疾病情感影响的讨论。
外行人教育者在提供自我管理教育时带来了许多细微差别明显的技能和知识。该角色所需的发展和培训受到政策层面资金限制的阻碍。对来自“社区”的理解与外行人角色的身份和地位相关联，与种族、民族和语言的概念相互重叠。
