Rahman Mahfuzur, Khatri Resham B, Gomersall Sjaan, Hossian Mosharop, Khan Asaduzzaman
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.
School of Public Health, The University of Queensland, Brisbane 4006, Australia.
Int J Environ Res Public Health. 2025 Aug 15;22(8):1279. doi: 10.3390/ijerph22081279.
Healthcare service utilisation for type 2 diabetes (T2D) is suboptimal among people from culturally and linguistically diverse (CALD) backgrounds. Synthesised evidence on drivers influencing their healthcare access and utilisation across the continuum of care (CoC) is scarce. This review synthesised drivers of accessing and utilising healthcare services across the CoC for T2D from the perspectives of people from CALD backgrounds and their healthcare service providers (HSPs). Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched from inception to November 2023. This review was prospectively registered with PROSPERO (ID: CRD42023491560). The McGill Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of articles included in this systematic review. Studies were included if they were primary research involving people from CALD backgrounds and/or their HSPs, and reported data related to access to and utilisation of services across the CoC. The CoC framework was used to conduct a guided thematic analysis for qualitative findings and narrative synthesis was used to summarise quantitative findings. Thirty-five studies were included: 31 qualitative, 3 quantitative, and 1 mixed-method. Psychosocial (e.g., fear of treatment) and sociocultural barriers (e.g., stigma) were reportedly encountered at diagnosis and initiation of treatment. Language and cultural barriers were expressed by most people with T2D and their HSPs, especially at the monitoring and adherence stages of the CoC. Trusted relationships with HSPs and the cultural competency of the HSPs were facilitators of continued monitoring and adherence and long-term care and management. No barriers or facilitators were identified for decision-making to enter the healthcare systems, screening, and first point of contact aspects of the CoC from the perspectives of either patients or HSPs. Although included articles were heavily skewed towards qualitative studies, the synthesised evidence on factors influencing access to and utilisation of healthcare services for T2D can inform policymaking by highlighting pathways to improved use of healthcare services among these groups.
在文化和语言背景多样（CALD）的人群中，2型糖尿病（T2D）的医疗服务利用情况并不理想。关于影响他们在连续医疗过程（CoC）中获得和利用医疗服务的驱动因素的综合证据很少。本综述从CALD背景人群及其医疗服务提供者（HSPs）的角度，综合了T2D患者在CoC中获得和利用医疗服务的驱动因素。检索了五个数据库（Scopus、PubMed、Web of Science、CINAHL和PsycINFO），检索时间从建库至2023年11月。本综述已在PROSPERO（注册号：CRD42023491560）进行前瞻性注册。使用麦吉尔混合方法评估工具（MMAT）来评估纳入本系统综述的文章质量。如果研究是涉及CALD背景人群和/或其HSPs的原始研究，并报告了与CoC中服务获得和利用相关的数据，则纳入该研究。CoC框架用于对定性研究结果进行引导式主题分析，叙述性综合用于总结定量研究结果。共纳入35项研究：31项定性研究、3项定量研究和1项混合方法研究。据报道，在诊断和开始治疗时会遇到心理社会障碍（如对治疗的恐惧）和社会文化障碍（如耻辱感）。大多数T2D患者及其HSPs表示存在语言和文化障碍，尤其是在CoC的监测和依从阶段。与HSPs的信任关系以及HSPs的文化能力是持续监测、依从以及长期护理和管理的促进因素。从患者或HSPs的角度来看，在CoC的进入医疗系统决策、筛查和首次接触方面，未发现任何障碍或促进因素。尽管纳入的文章严重偏向定性研究，但关于影响T2D患者获得和利用医疗服务的因素的综合证据可以通过突出改善这些群体医疗服务利用的途径，为政策制定提供参考。
