Health Needs Assessment of Black and Minority
Ethnic Patients with Diabetes in NHS Fife
Miss Chanda Bhogaita RD
Diabetes Managed Clinical Network
NHS Fife
March 2011
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 1 of 90
Date: 26/01/11
Review Date: 27/01/11
Acknowledgements
We would like to sincerely thank all the black and minority ethnic people with
diabetes who provided their views and experiences about the services they
receive in NHS Fife.
We would also like to thank all the healthcare professionals who provided
information about their work and experiences of delivering services for black and
minority ethnic people with diabetes in NHS Fife
We would like to acknowledge the following people for their help, guidance and
support throughout the project:
Community engagement and participation



Dr Daksha Patel (Health Advocacy Worker, Frae Fife)
Ms Angela Heyes (Equality and Diversity Lead, NHS Fife)
Mr Sandy Kopyto (Principle Clinical Pharmacist, NHS Fife)
Academic supervision


Professor Helen Colhoun (Professor of Public Health University of
Dundee/Honorary Consultant in Public Health, NHS Fife)
Dr David Chinn (Research Coordinator, NHS Fife)
Information analysis

Mr Bryan Archibald (Senior Information Analyst, NHS Fife)
Literature searches

Ms Dorothy Woolley (Public Health Librarian, NHS Fife)
Administrative support



Ms Kirsty Jablonski (MCN Administration, NHS Fife)
Ms Corol Kerr (MCN Administration, NHS Fife)
Ms Gillian Pickford (MCN Administration, NHS Fife)
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 2 of 90
Date: 26/01/11
Review Date: 27/01/11
Contents
Executive summary …….......................................................................................4
1. Introduction
…….......................................................................................6
2. Aims and objectives.........................................................................................7
3. Methodology....................................................................................................8
4. Epidemiology..................................................................................................10
5. Population Profile............................................................................................12
6. Best practice in diabetes services for BME patients.......................................18
7. Local diabetes services for BME patients.......................................................22
8. Clinical outcomes for Pakistani patients with type 2 diabetes.........................23
9. Consultations...................................................................................................29
10. Key findings………………………………………………………………………….56
11. Conclusion…………………………………………………………………………..58
12. Recommendations………………………………………………………………….59
References………………………………………………………………………………61
Appendices……………………………………………………………………………...69
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 3 of 90
Date: 26/01/11
Review Date: 27/01/11
Executive Summary
Scotland has continued to see a steady rise in the prevalence of diabetes with
type 2 diabetes accounting for 85-90% of all diagnosed cases. Some people from
black and minority ethnic (BME) groups are more likely to develop type 2
diabetes, at a younger age and lower thresholds for body mass index and waist
circumference compared to the general population. In addition, people from BME
backgrounds are at increased risk of developing serious complications associated
with type 2 diabetes, approximately five to ten years in advance of their European
counterparts.
It is recognised that some people from BME groups may experience difficulties
accessing healthcare services and receive poor diabetes care due to
discrimination, racism, cultural, religious and language barriers.
Tackling
inequalities and addressing the needs of people from BME communities is set in
the wider context of the Government‟s equality and diversity agenda.
NHS Fife undertook this review to assess the needs of BME patients with
diabetes and healthcare providers, in order to improve the delivery of culturally
competent services. A combination of quantitative and qualitative research
methodologies were used to ensure robust assessment with tangible outcomes.
Key findings identified; a lack of ethnicity and cultural data recording, poorer
diabetes clinical outcomes for Pakistani patients with type 2 diabetes compared to
the general Fife population, the need for culturally sensitive care and education
with appropriate language support, the need for healthcare staff training, and the
need for adequate resources to improve integration of BME care and education
into mainstream diabetes services.
The relatively small BME population and disperse geographical distribution has
implications on how diabetes services can be equitably delivered in NHS Fife.
The review process identified 3 broad themes to improve the local delivery of
culturally competent care and education; the recommendations from each of
these themes are listed below:
Internal policies and procedures

Improve the recording of ethnicity and cultural data using the Scottish
Census 2011 ethnic classifications and National Resource Centre for
Ethnic Minority Health ethnic monitoring toolkit for guidance.

Generate data about the diabetes clinical outcomes in BME groups to
compare with the total Fife population, in partnership with EMIS, Vision and
SCI-DC.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 4 of 90
Date: 26/01/11
Review Date: 27/01/11

Urgently address the need for permanent funding to support diabetes
services to develop a sustainable service model linked as closely to
mainstream services as possible to ensure that BME patients receive
culturally sensitive and language appropriate diabetes care and education.
BME patients care, education, information and support needs

Establish clear lines of communication with local BME groups to identify
needs and support access to culturally sensitive mainstream diabetes
services, in partnership with Patient Focus and Public Involvement.

Design a referral pathway to identify BME patients suitable for culturally
sensitive educational programmes delivered by a healthcare professional
with an interpreter (if required), trained BME health link worker or bilingual
healthcare professional.

Develop a protocol for dissemination of information about resources, local
services and health initiatives using effective communication methods e.g.
trained interpreters, Frae Fife, BME communities or faith groups.
Healthcare staff training and information needs

Provide training for healthcare staff in partnership with equality and
diversity about culturally competent practice and service delivery e.g. wider
issues around racism, BME cultural practices and health needs, resources
and the appropriate use of interpreting services.

Provide training for interpreters in partnership with interpretation and
translation services about the use of medical terminology, style of
healthcare consultations and delivering group education sessions.

Develop a web page on the intranet together with the three community
health care partnerships with information about BME information
resources, local sources of support, literature produced by the National
Resource Centre for Ethnic Minority Health (NRCEMH), and “NHS Fife
Diabetes Handbook” updated to include a chapter on the management of
BME patients with diabetes.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 5 of 90
Date: 26/01/11
Review Date: 27/01/11
1.0 Introduction
Diabetes is recognised as one of the most challenging health and socio-economic
problems in the world. The estimated global prevalence of diabetes is 285 million
people, which represents 6.6% of the world‟s adult population. By 2030, this is
projected to rise to 438 million people, which represents 7.8% of the world‟s adult
population.1
Diabetes is a significant contributor to mortality and morbidly associated with its
short and long term complications such as hypoglycaemia, diabetic ketoacidosis,
hyperosmolar hyperglycaemic state, cardiovascular disease, retinopathy,
neuropathy and nephropathy. In the UK there are 2.8 million people diagnosed
with diabetes, which represents 4.26% of the UK‟s population, and an estimated
850,000 people who remain undiagnosed.2
Scotland has continued to see a steady increase in the prevalence of diabetes
which poses serious clinical and financial concerns. In Scotland there are
228,004 people diagnosed with diabetes, which represents a crude prevalence of
4.4%, and an estimated 20,000 people who remain undiagnosed.3
Diabetes is the most common endocrine disorder, with type 2 diabetes accounting
for 85-90% of all diagnosed cases.4 Type 2 diabetes is characterised by insulin
resistance and relative insulin deficiency and is associated with older age,
overweight and obesity. Some black and minority ethnic (BME) groups including
people with African, Asian and Caribbean backgrounds are at a greater risk of
developing type 2 diabetes, at a younger age (25 years and over compared with
40 years and over in Europeans) and lower thresholds for body mass index and
waist circumference (in people of Asian descent).4,5,6 In addition, they are at
increased risk of developing complications associated with type 2 diabetes, five to
ten years in advance of their European counterparts.7,8,9
It is recognised that some people from minority ethnic groups may experience
difficulties accessing healthcare services and receive poor diabetes care due to
discrimination, racism, cultural, religious and language barriers.10, 11, 12
Tackling inequalities and addressing the needs of people from minority ethnic
communities is set in the wider context of the Government‟s equality and diversity
agenda. Policies such as Fair for All13 and the Race Relations (Amendment) Act
200014 have lead to the development of local schemes15 which promote the
delivery of culturally competent services.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 6 of 90
Date: 26/01/11
Review Date: 27/01/11
2.0 Aim and objectives
The aim of the project was:
To assess the needs of BME patients with diabetes and healthcare providers, in
order to make recommendations for the provision of culturally competent services
in NHS Fife
The objectives of the project were:

To describe the epidemiology of diabetes in BME groups in NHS Fife

To identify best practice in providing services for BME patients with
diabetes

To determine services provided for BME patients with diabetes in NHS Fife

To generate information about clinical outcomes for Pakistani patients with
type 2 diabetes in NHS Fife

To obtain views from Chinese and Pakistani patients with diabetes about
the services they receive in NHS Fife

To obtain information from healthcare professionals about the services
they provide for BME patients with diabetes in NHS Fife

To make recommendations for enhancing current services in order to meet
the needs of BME patients with diabetes in NHS Fife
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 7 of 90
Date: 26/01/11
Review Date: 27/01/11
3.0 Methodology
In order to meet the aim and objectives of the project, the approach was based on
the five steps of health needs assessment outlined by the National Institute for
Clinical Excellence.16 A combination of quantitative and qualitative research
methodologies were used to ensure robust assessment with tangible outcomes.
Step 1 – Getting started
A project board consisting of key stakeholders was established to agree a plan
outlining the study population, aim of assessment, capacity and scope of the
project.
After careful consideration of several factors such as the size of local BME
population, health priorities, likely availability of data, feasibility and timescales of
the project, it was decided to focus on people from Pakistani, Chinese and
Migrant worker e.g. Polish backgrounds.
Step 2 – Identifying health priorities
In order to estimate the BME population with diabetes in Fife a profile was created
using population data from the Scottish Census 200117 prevalence data from the
Health Survey for England 200418 and various smaller scale pieces of research in
BME groups6.
A manual review of the electronic medical records of Pakistani patients with type
2 diabetes in NHS Fife was conducted. SCI-DC was used to search for Pakistani
patients based on name. This technique could not be applied to accurately find
patients from other BME groups. The diabetes outcomes for Pakistani patients
with type 2 diabetes were compared to general Fife outcomes.
A literature review was undertaken to identify best practice in providing services
for BME patients with diabetes. Findings from this together with scoping work to
determine current services provided in NHS Fife for BME patients, revealed
potential areas for service improvement and resource allocation.
Qualitative information was gathered about the population‟s perceptions of needs
using community engagement and participation methods. Frae Fife‟s health
advocacy worker was instrumental in creating links between the researcher and
local BME communities. Snowballing techniques proved to be successful at
recruiting Pakistani and Chinese participants however, unsuccessful at recruiting
Polish. Further investigation into reasons for non-participation of migrant workers
in research is needed.
Focus groups, held in community venues were used to elicit views from Pakistani
and Chinese patients with diabetes about the services they receive in NHS Fife.
Four main areas for consultation were identified, and a semi-structured interview
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 8 of 90
Date: 26/01/11
Review Date: 27/01/11
schedule was used to capture data (please see appendix 1). Focus group
discussions and important aspects of the group's interaction were all documented.
Data was analysed to identify conceptual categories. The focus groups enable
participants to contribute to wider discussions around service planning.
Qualitative information was gathered about the interpreter‟s perceptions of needs
through community engagement and participation methods⁶. The NHS Fife lead
for equality and diversity was instrumental in creating links between the
researcher and local interpreters. Focus groups were used to obtain views from
interpreters about the services they provide for BME patients with diabetes.
Seven main areas for consultation were identified, and a semi-structured interview
schedule was used to capture data (please see appendix 2). Focus group
discussions and important aspects of the group's interaction were all documented.
Data was analysed to identify conceptual categories. The focus groups provided
an opportunity for cross-sectoral partnership working.
Quantitative information was gathered about the service providers‟ perceptions of
needs. A questionnaire was used to obtain views from healthcare professionals
about the services they provide for BME patients with type 2 diabetes. Seven
main areas for consultation were identified, and a survey monkey questionnaire
was designed to capture data (please see appendix 3). Data was analysed to
look for trends and patterns in responses to identify areas for developing effective
interventions.
The key issues for the Pakistani and Chinese populations, interpreters and
service providers were established based on evidence from extrapolated data and
focus group discussions.
Step 3 – Assessing a health priority for action
The interventions considered most effective and acceptable were prioritised and
resource allocation discussed with the Diabetes MCN board.
Step 4 – Action planning for change
Recommendations for providing culturally competent services in NHS Fife were
made. An action plan will be established to be taken forward by the Diabetes
MCN as part of their commitment to the diabetes action plan 2010.
Step 5 – Moving on/project review
After review of the projects achievements, the results were disseminated to
participants and stakeholders. A steering group will be established to take
responsibility for the implementation of the recommendations.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 9 of 90
Date: 26/01/11
Review Date: 27/01/11
4.0 Epidemiology
Prevalence of diabetes in BME groups
There is limited data on the incidence of diabetes in BME populations, due to a
lack of large scale studies with follow-up phases and maintenance of accurate
population-based registers.5
Research states that people from BME groups are at a greater risk of developing
type 2 diabetes compared to the general population. Table 1 below shows the
most recent self-reported data on doctor-diagnosed type 2 diabetes prevalence.
Table 1: The Prevalence of Doctor-diagnosed Type 2 Diabetes by Sex and Ethnic
Group, 2004, England18
Black
Caribbean
Black
African
Men
Prevalence of type 2 diabetes (%)
Type 2
9.5
4.3
Standardised risk ratios
Type 2
2.37
2.17
Standard error
0.65
0.71
of the ratio
Women
Prevalence of type 2 diabetes (%)
Type 2
7.6
2.0
Standardised
risk ratios
Type 2
3.16
2.14
Standard error
0.53
0.73
of the ratio
Indian
Pakistani
Bangladeshi
Chinese
General
Population
9.0
7.3
8.0
3.4
3.8
3.17
0.52
3.27
0.66
4.59
0.94
1.44
0.44
1
5.9
8.4
4.5
3.3
3.1
2.95
0.55
6.25
1.05
3.64
0.90
2.06
0.58
1
The observed prevalence of doctor-diagnosed type 2 diabetes was significantly
higher in Pakistani men and women than in the general population.
After adjusting for age, doctor-diagnosed type 2 diabetes was over three times as
likely in Pakistani men compared to men in the general population. Among
women, doctor-diagnosed type 2 diabetes was over six times as likely in Pakistani
women compared to women in the general population.
Further data on estimated diabetes prevalence, based on oral glucose tolerance
tests in South Asians suggests a four to six fold higher prevalence of diabetes in
South Asian people compared to Europeans.19, 20, 21 The Phase 3 PBS model
states the greatest diabetes prevalence among South Asians.22
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 10 of 90
Date: 26/01/11
Review Date: 27/01/11
Prevalence of diabetes associated complications in BME groups
It is widely acknowledged that some minority ethnic populations are at increased
risk of developing complications associated with type 2 diabetes compared to
European populations.5, 23
CHD is more common in South Asians, presents at a younger age and has a 50
per cent higher mortality compared to Europeans.24, 25 The elevated CHD
mortality has been linked to the number of people with diabetes as a result of
insulin resistance and other related atherogenic risk factors such as a lipid profile
of low HDL cholesterol, high triglycerides and higher Lipoprotein(a).26, 27
Stroke is also more common in South Asians, occurs at a younger age and has a
40 per cent higher mortality compared to Europeans. 28 Diabetes has been
identified as a strong predictor of stroke mortality in South Asians.29
Diabetic retinopathy is also more prevalent in South Asians compared to
Europeans.30 The younger age of onset, longer duration of diabetes, poorer
glycaemic, blood pressure and lipid control may explain the higher level of
microvascular complications observed in South Asians.31
The prevalence, rates of progression and mortality associated with diabetic
nephropathy vary significantly between ethnic groups. 32 Studies suggest a two- to
threefold higher prevalence of overt nephropathy in South Asians.33, 34, 35
Furthermore, South Asians are more likely to have severe disease (CKD stages 4
and 5) compared to Europeans, suggesting a faster progression of renal
disease.36
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 11 of 90
Date: 26/01/11
Review Date: 27/01/11
5.0 Population profile of BME groups living in Fife
Population
In 2001, there were 4426 people from BME groups living in Fife, which
represented 1.3% of the total population.37 Of these the largest BME groups were
Pakistani, followed by Chinese, Indian and those of Any Mixed Backgrounds. 38
Figure 1, illustrates the proportions of BME groups living in Fife.
Figure 1: Non-white Fife Population, by Ethnic Group: 2001
The 2001 Census data is likely to have underestimated the true BME population
as figures for Refugees & Asylum Seekers, recent migrant workers, and
Gypsy/Travellers were not included.
In Fife, the BME population increased by nearly 50% between 1991 and 2001.39
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 12 of 90
Date: 26/01/11
Review Date: 27/01/11
Age
For both males and females, ethnic minority groups have a younger age profile
than the white population in Fife.40 Figure 2, illustrates the distribution of
population by ethnic group and age in Fife.
Figure 2: Distribution of Population by Ethnic Group and Age in Fife: 2001
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 13 of 90
Date: 26/01/11
Review Date: 27/01/11
Deprivation
Figure 3, illustrates the distribution of Fife‟s population by ethnic group and
Scottish Index of Multiple Deprivation (SIMD) deprivation quintile. People from
Indian and Chinese backgrounds are more likely to live in the least deprived
quintile. Whereas, Pakistanis and other South Asians are more likely to live in the
most deprived two quintiles and the least deprived quintile.40
Figure 3: Distribution of Fife Population by Ethnic Group and Fife SIMD2009
Quintile: 2001
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 14 of 90
Date: 26/01/11
Review Date: 27/01/11
Geography
Fife's BME population is smaller compared to larger cities such as Glasgow (5.5%
of the population), Edinburgh (4.1), Dundee (3.7) and Aberdeen (2.9).38 Figure 4
illustrates the percentage of each council area that are minority ethnic.
Figure 4: Percentage of people in each council area that are minority ethnic,
2001
Minority Ethnic Residents (%)
Fife contains a significant rural population which is characterised by disperse
geographical distribution. It is therefore probable that the experiences of BME
groups in Fife may differ from those in the other areas such as Edinburgh or
Glasgow.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 15 of 90
Date: 26/01/11
Review Date: 27/01/11
Prevalence of diabetes
At the beginning of 2010 there were 16,759 people with known diabetes in Fife,
which represented a crude prevalence of 4.6% of the total population.3 The
majority of registered patients had type 2 diabetes, 87.8%.3
Data on ethnicity was available for only 26.0% of the registered diabetic
population in NHS Fife³ therefore it was not possible to accurately calculate the
number of BME people with diabetes from SCI-DC. Table 2, shows the estimated
diabetes prevalence in NHS Fife by CHP and ethnicity.
The following
assumptions were used to generate data:




CHPs have the same proportions of BME population as in the Scottish
Census 200117
Type 2 diabetes is 6 times more likely in South Asians compared to the
white population.⁶
Type 2 diabetes is 3-5 times (4) times more likely in the Black African
Caribbean community compared with the white population.⁶
The prevalence of diabetes in the Chinese community is around 1 in 20
(5%).⁶
Table 2: The estimated diabetes prevalence in NHS Fife by CHP and ethnicity
CHP
Dunfermline & West
Fife CHP
Glenrothes & NE Fife
CHP
Kirkcaldy &
Levenmouth CHP
Ethnicity
Prevalence
All
Type1 Type2
ALL
White
Chinese
Indian
Pakistani
Other South Asian
Black
Other
ALL
White
Chinese
Indian
Pakistani
Other South Asian
Black
Other
ALL
White
Chinese
Indian
Pakistani
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
All
Diabetics
Type1 Type2
Version: 1
Page 16 of 90
6038
5801
14
43
114
22
25
19
642
617
2
5
12
2
3
2
5375
5164
12
38
102
20
22
17
4.1%
4.0%
5.0%
24.1%
24.1%
24.1%
16.1%
4.0%
0.4%
0.4%
0.6%
2.6%
2.6%
2.6%
1.7%
0.4%
3.7%
3.6%
4.4%
21.5%
21.5%
21.5%
14.3%
3.6%
4831
4615
20
42
74
28
29
22
608
581
3
5
9
4
4
3
4188
4001
17
37
64
24
25
19
3.8%
3.7%
5.0%
22.1%
22.1%
22.1%
14.7%
3.7%
0.5%
0.5%
0.7%
2.8%
2.8%
2.8%
1.9%
0.5%
3.3%
3.2%
4.3%
19.1%
19.1%
19.1%
12.8%
3.2%
4071
3871
7
40
103
461
438
1
4
12
3601
3424
6
35
91
4.1%
4.0%
5.0%
23.7%
23.7%
0.5%
0.4%
0.6%
2.7%
2.7%
3.6%
3.5%
4.4%
21.0%
21.0%
Date: 26/01/11
Review Date: 27/01/11
NHS Fife
Other South Asian
Black
Other
ALL
White
Chinese
Indian
Pakistani
Other South Asian
Black
Other
16
25
9
14940
14276
40
128
298
67
81
50
2
3
1
1711
1635
5
15
34
8
9
6
14
22
8
13164
12579
35
112
262
59
72
44
23.7%
15.8%
4.0%
4.0%
3.9%
5.0%
23.3%
23.3%
23.3%
15.5%
3.9%
2.7%
1.8%
0.4%
0.5%
0.4%
0.6%
2.7%
2.7%
2.7%
1.8%
0.4%
21.0%
14.0%
3.5%
3.5%
3.4%
4.4%
20.5%
20.5%
20.5%
13.7%
3.4%
In addition to the BME groups listed in the table above, people from other BME
groups such as Refugees & Asylum Seekers, Migrant workers e.g. Polish, and
Gypsy/Travellers, will also have diabetes. However, estimating the number of
people with diabetes in these populations was not possible due to a lack of
information from the Census 2001. This problem may be rectified by the
introduction of new ethnic classifications in the Scottish Census 2011 (Please see
appendix 4).
It was estimated that 664 people from BME communities had diabetes, which
represented 4.4% of the total population in Fife. Type 2 diabetes accounted for
majority of cases (87.95%). Of these the greatest prevalence was observed in
the South Asian population (74.1%). Figure 5, illustrates the proportion of BME
groups with type 2 diabetes in NHS Fife.
Figure 5: BME Groups with Type 2 Diabetes in NHS Fife
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 17 of 90
Date: 26/01/11
Review Date: 27/01/11
6.0 Best practice in diabetes services for BME patients
National policy and guidance
Providing world class care which is equitable, effective and person-centred for
people from BME communities is an important strand of the NHS Quality
Strategy.41
The Scottish Diabetes Framework 200242, Scottish Diabetes Framework Action
Plan 200643, Better Diabetes Care Consultation Document44 which contributed to
the development of the Scottish Diabetes Action Plan 201045 have been
instrumental in establishing a programme of interventions to improve the quality of
diabetes services and outcomes for BME patients with diabetes.
Other drivers of improvements in diabetes services are; the Scottish
Intercollegiate Guidelines Network (SIGN) 11646, NHS Quality Improvement
Scotland, Diabetes Clinical Standards47 and follow-up report48, and the General
Medical Services contract which provides a set of quality indicators within a
Quality and Outcomes Framework (QOF).49
The National Resource Centre for Ethnic Minority Health (NRCEMH) has been
instrumental in improving services for BME patients with diabetes. Table 3,
describes some of their most influential resources.
Table 13: Resources produced by the NRCEMH50
Name of resource
Purpose
Year
published
Diabetes in Minority
Ethnic Groups in
Scotland51
The purpose of this report is to
stimulate ideas and learning that will
help those who care for people with
diabetes from BME groups to develop
a framework to run multi-disciplinary
programmes.
2004
Current Status of Cultural
Competency Training in
NHS Scotland52
Review of all training relating to
cultural competency within the NHS
organisations.
2004
Peer Review Toolkit53
Methodology to evaluate cultural
competency training programmes.
2004
Aims to share good practice while
providing a supportive feedback for
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 18 of 90
Date: 26/01/11
Review Date: 27/01/11
continuous improvement
Ethnic Monitoring
Toolkit54
The Toolkit incorporates guidelines
and training resources to support the
planning and implementation of patient
ethnicity within
NHS Scotland.
2005
Focus on Diabetes6
The resource pack provides
information for health staff working
with BME patients with diabetes.
2007
Now we‟re really
talking – Interpreting
Guidelines for staff of
NHS Scotland55
This document provides useful
guidelines on working with
interpreters.
2008
Final Report
Achievements and
challenges in
ethnicity and health in
NHS Scotland50
This is the final report covering the
achievements of last six years by the
National Resource Centre for Ethnic
Minority Health.
2009
Diabetes UK has worked to promote the delivery of culturally competent services
for BME people with diabetes. It produced a checklist56 which enabled healthcare
providers to assess the cultural competence of their diabetes services, with
specific reference to issues around cultural sensitivities, need for an interpreter,
patients reading ability, need for education/information, lifestyle and dietary
matters, awareness of patients of local sources of information or support,
awareness of patients of diabetes UK‟s free language materials and Careline
interpreting service. This work informed the development of “Focus on Diabetes”
in partnership with the NRCEMH.
Evidence
A literature review was conducted to identify best practice in providing services for
BME patients with diabetes. Critical analysis focused on the following areas
required to provide culturally competent services:
Types of intervention
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 19 of 90
Date: 26/01/11
Review Date: 27/01/11
There is insufficient evidence to support intensive medical interventions in BME
patients with diabetes. However, there is good quality evidence linking culturally
competent educational programmes with improved levels of knowledge and
glycaemic control in this high risk group.57, 58, 59, 60 Whilst educational programmes
have been accredited with influencing improvements in knowledge, their ability to
achieve positive biochemical outcomes needs further investigation.61
Health Link Workers
There is some evidence which suggests that health link workers are vital
components of diabetes service delivery for BME patients.62, 63 Their multifaceted
role in interpretation, advocacy and delivery of education programmes has been
linked with enhanced patient understanding and compliance.63, 64, 65, 66 Whilst it is
accepted that health link workers help to meet the communication needs of BME
patients in terms of delivering culturally sensitive information in their first
language, work is needed to assess their effectiveness and sustainability. 67, 68
Bilingual Healthcare Professionals
There is some evidence which suggests bilingual healthcare professionals have
an important role in terms of providing diabetes educational programmes for BME
patients.70, 71 Studies have identified a need for bilingual professionals with whom
BME patients can discuss their care directly without relying on an interpreter. 69
Interpreters
It is universally recognised that interpreters are instrumental in facilitating
communication between healthcare staffs and BME patients. There is good
quality evidence which advocates the use of professional interpreters rather than
friends or family members to ensure the accurate exchange of information.70
However, consideration needs to be given to the training needs of interpreters
e.g. in the use of medical terminology, their roles and responsibilities etc.70 In
addition, healthcare staffs may require guidance on the use of interpreters and
problems associated with informal interpreting arrangements.71
Cultural sensitivities
There is limited evidence to identify the factors which contribute to the
effectiveness of educational programmes for BME patients with diabetes due to
the low number and heterogeneity of studies available. 61 The BME community
consists of many disparate groups with widely differing needs and expectations
therefore health services need to design educational initiatives with an awareness
of the complexity of social and cultural experiences of local target communities.72,
73
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 20 of 90
Date: 26/01/11
Review Date: 27/01/11
Cultural competence in health care aims to meet the needs of patients with
diverse values, beliefs and behaviours. In order to provide culturally competent
diabetes services it is recommended that data about ethnic group, religion,
country of birth, ethnic/family origins, diet, preferred gender of health care
professionals, alternative medication and preferred language are recorded.51, 54
Service delivery should then be focused on addressing cultural sensitivities e.g.
appropriate language provision, culturally tailored advice, specialist information
resources, separate gender education sessions etc.67,72 Collecting cultural data
together with clinical outcomes and user involvement may lead to evidence-based
change, both at operational and strategic planning levels.51
Social networks
There is evidence which indicates that family and community networks are an
important source of knowledge and emotional support for BME patients with
diabetes.72 Many BME patients make changes based on the opinions and actions
of their trusted community members therefore peer led diabetes education
programmes have been used to increase knowledge and bring about positive
changes. However, their effectiveness needs to be investigated further.74, 75
It is imperative that health services are aware of local sources of information and
support which they can sign post to their BME patients with diabetes.
Lifestyle issues
There is good quality evidence that lifestyle intervention including a healthy diet
and regular physical activity can help to manage diabetes. However, uncertainty
exists around culturally specific lifestyle guidance for BME patients. Evidence
suggests that the dietary and physical activity advice given to BME patients is
often inadequate due to the practitioner‟s limited understanding of the patient‟s
lifestyle and cultural background.76, 77, 78
A culturally sensitive approach to lifestyle education based on an understanding
of cultural norms and social expectations is needed.78 Lifestyle strategies should
avoid any tendency to overemphasize cultural barriers noting greater similarities
than differences between cultural groups.78
In order to implement any lifestyle interventions training of healthcare staff may be
required.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 21 of 90
Date: 26/01/11
Review Date: 27/01/11
7.0 Services provided for BME patients with diabetes in NHS Fife
Current services
In NHS Fife the healthcare and education of BME patients with diabetes is
provided as part of mainstream services and ad hoc health promotion events.
The current model of care is delivered using interpreters and culturally sensitive
information resources.
A lack of adequate resource, staffing and funding prevents the development of a
strategy and sustainable service model to improve integration with mainstream
diabetes services.
NHS Fife employs a small number of bilingual healthcare professionals and has
access to Frae Fife health link workers. However, their lack of formal diabetes
training and existing workloads does not allow them to contribute extensively to
diabetes services.
Recent developments
Whilst not aimed specifically at BME patients with diabetes, “Winning by Losing”
(a community weight management programme) was recently piloted in the South
Asian community with promising results. “Winning by Losing” currently operates
on time-limited funding, although NHS Fife is committed to mainstreaming the
service especially with view to long term condition management.
Resources
In addition to the above service, the following resources are available for BME
patients with diabetes:





The Minority Ethnic Structured Diabetes Education website and pack
Diabetes UK Careline
Diabetes UK resources
NHS Choices information about diabetes and heart disease for South
Asians
Scottish Nutrition and Diet Resources Initiative (SNDRi) and South Asian
Nutrition dietary information leaflets for South Asians
Services delivered in other areas
A full list of services delivered in other areas which may have an impact on
diabetes control can be found in, “Focus on Diabetes: A guide to working with
black and minority ethnic communities in Scotland living with long term conditions”
pages 53 – 706.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 22 of 90
Date: 26/01/11
Review Date: 27/01/11
8.0 Clinical outcomes for Pakistani patients with type 2 diabetes
The following section presents information about the clinical outcomes for
Pakistani patients with type 2 diabetes. In order to identify any inequalities which
may exist the clinical outcomes for the Pakistani population have been compared
to Fife‟s total population.
A manual review of electronic medical records found 195 Pakistani patients with
type 2 diabetes in NHS Fife. Given the estimated number of Pakistani patients
with type 2 diabetes in NHS Fife is 262 this would mean that approximately 74.4%
of records were analysed.
Statistical testing to identify significance differences between samples was not
performed as it was considered appropriate to report on observed values.
Gender
Table 3 below shows that more men than women have diagnosed type 2 diabetes
in the Pakistani population and Fife‟s total population. However, a greater
proportion of men in the Pakistani population have diagnosed type 2 diabetes
compared to men in Fife‟s total population.
Table 3: Proportion of Males and Females with type 2 diabetes in the Pakistani
Population and Fife‟s Total Population
Gender
Male
Female
Total
Pakistani
N
%
124
63.6%
71
36.4%
195
Fife
N
7967
6744
14718
%
54.1%
45.8%
Duration of type 2 diabetes
The date of diagnosis was recorded for 98.5% of the Pakistani population
compared to 98.8% of Fife‟s total population.
Table 4 below highlights that people in the Pakistani population experience a
longer duration of type 2 diabetes compared to Fife‟s total population.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 23 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 4: Duration of type 2 diabetes (years since diagnosis) in the Pakistani
Population and Fife‟s Total Population
Duration of Type 2
Diabetes
< 1 year
1 to 4
5 to 9
10 to 14
15 to 19
20 +
Not Recorded
Total
Pakistani
N
%
13
6.7%
47
24.1%
62
31.8%
42
21.5%
14
7.2%
14
7.2%
3
1.5%
195
Fife
N
1326
4598
4885
2127
936
670
176
%
9.0%
31.2%
33.2%
14.5%
6.4%
4.6%
1.2%
14718
Age
Table 5 below reveals that the Pakistani population has a younger age of onset
for type 2 diabetes compared to Fife‟s total population.
Table 5: Age group of people with type 2 diabetes in the Pakistani population and
Fife‟s total population
Age Group
< 25
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 +
Not Recorded
Total
Pakistani
N
%
0
0.0%
8
4.1%
28
14.4%
61
31.3%
44
22.6%
36
18.5%
17
8.7%
1
0.5%
0
0.0%
195
Fife
N
17
120
656
1977
3647
4458
3115
721
7
%
0.1%
0.8%
4.5%
13.4%
24.8%
30.3%
21.2%
4.9%
0.0%
14718
Type 2 diabetes
The majority of registered patients had type 2 diabetes in the Pakistani population
and Fife‟s total population.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 24 of 90
Date: 26/01/11
Review Date: 27/01/11
Ethnicity
Table 6 below, shows that the recording of ethnicity data was better in the
Pakistani population compared to Fife‟s total population.
Table 6: Recording of ethnic group in people with type 2 diabetes in the Pakistani
population and Fife‟s total population (Type 2 Diabetes)
Ethnicity
Recorded
NR/Incorrect
Total
Pakistani
N
%
59
30.3%
136
69.7%
Fife
N
3781
10937
195
14718
%
25.7%
74.3%
Body Mass Index
Body Mass Index (BMI) has been recorded for only 52.3% of Pakistani patients in
the previous 15 months compared to 90.3% in Fife‟s total population.
Table 7 below reveals a significantly higher proportion of obese and morbidly
obese people with type 2 diabetes in the Pakistani population compared to Fife‟s
total population.
Table 7: BMI categories of people with type 2 diabetes in the Pakistani population
and Fife‟s total population
Underweight
Healthy Weight
Overweight
Obese
Morbidly Obese
Pakistani
Range
N
< 18.5
0
18.5 - 22.9
2
23 - 24.9
12
25 - 34.9
65
35 +
23
Total Recorded
Not Recorded
102
93
BMI1
Fife
%
0.0%
2.0%
11.8%
63.7%
22.5%
Range
< 18.5
18.5 - 24.9
25 to 29.9
30 to 39.9
40 +
N
67
1564
4146
6031
1475
%
0.5%
11.8%
31.2%
45.4%
11.1%
13283
1435
Glycaemic Control
Glycaemic control (HbA1c) has been recorded for 85.1% of the Pakistani
population in the previous 15 months compared to 92% in Fife‟s total population.
Table 8 below shows a significantly poorer control of diabetes for people with type
2 diabetes in the Pakistani population compared to Fife‟s total population.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 25 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 8: HbA1c categories of people with type 2 diabetes in the Pakistani
population and Fife‟s total population
HAb1c
< 7.5
7.5 - 9.0
9.0 +
Total Recorded
Not Recorded
Mean
Pakistani
N
%
82
49.4%
53
31.9%
31
18.7%
166
29
7.7
Fife
N
9386
2694
1456
%
69.3%
19.9%
10.8%
13536
1182
7.2
Cardiovascular Risk
In the South Asian population diabetes is associated with an increased risk of
cardiovascular disease and it is therefore important to address cardiovascular risk
factors such as blood pressure (BP), cholesterol and smoking.
Blood Pressure
BP has been recorded for 88.2% of the Pakistani population in the previous 15
months compared to 95.6% in Fife‟s total population.
Table 9 below suggests better control of BP (systolic BP less than or equal to
130mmHg) for people with type 2 diabetes in the Pakistani population compared
to Fife‟s total population.
Table 9: BP categories of people with type 2 diabetes in the Pakistani population
and Fife‟s total population
Blood Pressure
≤ 140
> 140
≤ 130
> 130
Total Recorded
Not Recorded
Mean (aged 50 - Systolic
60)
Diastolic
Pakistani
N
%
150
87.2%
22
12.8%
109
63.4%
63
36.6%
172
23
125
74
Fife
N
10259
3805
6101
7963
%
72.9%
27.1%
43.4%
56.6%
14064
654
133
79
Cholesterol
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 26 of 90
Date: 26/01/11
Review Date: 27/01/11
Cholesterol was recorded in 85.6% of the Pakistani population in the previous 15
months compared to 92.2% in Fife‟s total population.
Table 10 below indicates similar levels of total cholesterol control in people with
type 2 diabetes in the Pakistani population and Fife‟s total population.
Table 10: Cholesterol categories of people with type 2 diabetes in the Pakistani
population and Fife‟s total population
Cholesterol
≤ 5mmol/l
> 5mmol/l
Total Recorded
Not Recorded
Mean (aged 50 60)
Pakistani
N
%
139
83.2%
28
16.8%
N
11251
2315
167
28
13566
1150
4.1
Fife
%
82.9%
17.1%
4.4
Smoking status
Smoking status was recorded for 98.97% of the Pakistani population in the
previous 15 months compared to 99.7% in Fife‟s total population.
Table 11 below identifies lower proportions of smokers in the Pakistani
populations compared to Fife‟s total population.
Table 11: Smoking status of people with type 2 diabetes in the Pakistani
population and Fife‟s total population
Smoking Status
Current
Ex
Never
Total Recorded
Not Recorded
Pakistani
N
%
27
14.0%
13
6.7%
153
79.3%
193
2
Fife
N
2977
5381
6305
%
20.3%
36.7%
43.0%
14663
55
HbA1c, BP and cholesterol targets
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 27 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 12 below shows that people with type 2 diabetes from the Pakistani
population are doing less well in reaching target levels for control of their blood
glucose, blood pressure and cholesterol compared to Fife‟s total population.
Table 12: Proportions of people with type 2 diabetes in the Pakistani population
and Fife‟s total population reaching target levels for control of their blood glucose,
blood pressure and cholesterol.
Target
HbA1c < 7% and Chol ≤ 5
HbA1c < 7% and DBP < 80
Chol ≤ 5 and DBP < 80
HbA1c < 7%, Chol ≤ 5 and DBP < 80
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Pakistani
N
%
52
26.7%
33
16.9%
93
47.7%
26
13.3%
Version: 1
Page 28 of 90
Fife
N
6523
5862
8364
4999
%
44.3%
39.8%
56.8%
34.0%
Date: 26/01/11
Review Date: 27/01/11
9.0 Consultations
A number of consultations were conducted to obtain the views of relevant
stakeholders. These included:



Focus groups with Pakistani and Chinese patients with diabetes
Focus group with interpreters working with BME patients with diabetes
Questionnaires sent to diabetes healthcare professionals working in acute and
primary care settings
Results from previous qualitative research carried out by Diabetes UK in
association with Frae Fife amongst local South Asian and Chinese populations
with diabetes provided a baseline for the consultation exercises.
Focus groups with Pakistani and Chinese patients with diabetes
In total 35 Pakistani participants, 23 women and 12 men were recruited. From
these figures, 23 participants had type 2 diabetes, 4 participants had impaired
glucose tolerance, 5 participants cared for someone with diabetes and 3
participants wanted to learn more about diabetes.
In total 23 Chinese participants, 13 women and 10 men were recruited. From
these figures, 12 participants had type 2 diabetes, 4 participants had impaired
glucose tolerance, 2 participants cared for someone with diabetes and 5
participants wanted to learn more about diabetes.
Focus group discussions were based on the Diabetes UK publication, „Diabetes
care and you. What diabetes care you can expect‟.79 The following themes
emerged:




Patients expectations of NHS Fife
Patients views about working together with their diabetes healthcare team
Patients views about what care to expect from their diabetes healthcare
team
Patients roles in looking after their diabetes
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 29 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 14: Expectations of Chinese and Pakistani patients with diabetes of NHS Fife
Chinese patients with type 2 diabetes
Pakistani patients with type 2 diabetes
Access to services
Do you feel your race, religion or belief
has affected your access to services?
No participants felt they were
discriminated against.
Some participants felt their religion
affected their access to healthcare e.g.
appointments arranged on Friday‟s or
during Ramadan were not suitable.
All participants felt they received high
quality care that was safe, effective
and right for them.
All participants felt they received high
quality care that was safe, effective
and right for them however; it was not
always culturally sensitive.
Quality of care
What do you feel about the quality of
care you receive?
All participants felt they were treated
with dignity and respect.
Some participants felt that they were
not treated appropriately e.g.
“You must feel awful having to wear
that black robe”
“Is that colored man waiting outside
your husband?”
“Isn‟t everyone called Mohammed”
“Does it really matter if it‟s not Halal”
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 30 of 90
Date: 26/01/11
Review Date: 27/01/11
Information and choice
Have you been given any information
about your treatment (risks, benefits,
alternative treatments etc)?
The majority of patients reported to
have been given information.
However, some participants felt they
could not understand the information
provided due to terminology, language,
and lack of culturally appropriate
information.
The majority of patients reported to
have been given information.
However, some participants felt they
could not understand the information
provided due to terminology, language,
and lack of culturally appropriate
information.
Are you aware that you have a choice
to accept or refuse treatment?
All participants were aware they
needed to give valid consent before
any physical examination or treatment.
The majority of participants were
aware they needed to give valid
consent before any physical
examination or treatment. However,
some participants felt they did not
understand the procedure for which
they were giving consent.
What do you think about privacy and
confidentiality in the NHS?
All participants reported the NHS had
kept their information safe and secure.
The majority of participants reported
the NHS had kept their information
safe and secure. However, some
participants mentioned cases of “mixed
up” records due to poor understanding
of South Asian naming systems and
administration errors.
Have you ever asked to see your
health records and/or received copies
of letters about your care?
No participants had seen their health
records or received copies of letters
about their care. Participants were
unsure about how to request personal
information.
No participants had seen their health
records or received copies of letters
about their care. Participants were
unsure about how to request personal
information.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 31 of 90
Date: 26/01/11
Review Date: 27/01/11
Have you made any choices about
your NHS care?
All participants had made choices
about their NHS care based on reliable
and relevant advice from healthcare
professionals.
All participants had made choices
about their NHS care based on reliable
and relevant advice from healthcare
professionals.
Have you been informed about the
health services available to you?
The majority of participants were
aware of different health services but
did not know which ones were
available to them or how to access
services.
The majority of participants were
aware of different health services but
did not know which ones were
available to them or how to access
services.
Have you been involved in discussions
and decisions about your healthcare,
and be given information to help you
with this?
The majority of participants reported to
have discussed and made decisions
about their healthcare. However, the
information provided to help with this
was often difficult to understand due to
the terminology and language used.
The majority of participants reported to
have discussed and made decisions
about their healthcare. However, the
information provided to help with this
was often difficult to understand due to
the terminology and language used.
Have you had a say in the planning of
healthcare services to the NHS?
The majority of participants had not
had a say in planning healthcare
services. However, some would like
to give their views but were unsure
how to provide information.
The majority of participant had not had
a say in the planning of healthcare
services. However, some would like
to give their views but were unsure
how to provide information.
Working together with your
healthcare team
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 32 of 90
Date: 26/01/11
Review Date: 27/01/11
Complaints
Have you ever made any complaints
about NHS services?
No participants had made any
complaints about NHS services.
Participants were unsure how they
would make complaints but were keen
to stress that they had nothing to
complain about.
The majority of participant had not
made any complaints about NHS
services. Participants were unsure how
they would make complaints and if
these would be properly investigated
and dealt with appropriately.
Working together with your diabetes healthcare team
Table 15: Views of Chinese and Pakistani patients with diabetes about working together with their healthcare
team
Chinese patients with type 2
diabetes
Pakistani patients with type 2
diabetes
Where is your diabetes care provided?
The majority of participants care was
provided in GP surgeries. However, a
few participants were seen in hospital.
The majority of participants care was
provided in GP surgeries. However, a
few participants were seen in hospital.
Have you been referred to see any
specialists in a health centre or
hospital?
All participants reported to have seen a All participants reported to have seen a
GP, practice nurse, pharmacist,
GP, practice nurse, pharmacist,
podiatrist and retinal screener.
podiatrist and retinal screener.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
No participants reported to have seen
a dietitian.
Very few participants reported to have
seen a dietitian.
No participants reported to have seen
a district nurse, midwife, health visitor
No participants reported to have seen
a district nurse, midwife, health visitor
Version: 1
Page 33 of 90
Date: 26/01/11
Review Date: 27/01/11
Do you know the roles and
responsibilities of those providing your
diabetes care?
or psychologist.
The majority of participants were
aware of the types of the healthcare
professionals involved in their diabetes
care. However, there was little
understanding about the roles and
responsibilities of those providing their
diabetes care e.g.
or psychologist.
The majority of participants were
aware of the types of the healthcare
professionals involved in their diabetes
care. However, there was little
understanding about the roles and
responsibilities of those providing their
diabetes care e.g.
“I go to my appointment. I don‟t
“I just go to my appointment. I don‟t
question what happens”
know what the specialist‟s job is”
“No one has told me what care I should
expect”
Planning your care with your diabetes
healthcare team; are you actively
involved in deciding how your diabetes
will be managed?
The majority of participants reported to
be involved in deciding how their
diabetes should be managed.
However, some participants reported:
The majority of participants reported to
be involved in deciding how their
diabetes should be managed.
However, some participants reported:
“They don‟t ask me what I think”
“I don‟t know the different options”
“They don‟t ask what I think. They just
tell me what to do”
During your appointments, do you
discuss your concerns and questions
with members of your healthcare
team?
The majority of participants reported to
discuss their concerns and questions
with members of the healthcare team.
The majority of participants reported to
discuss their concerns and questions
with members of the healthcare team
with varying degrees of satisfaction.
Diabetes related topics participants
would like more information about
included:
Education about diabetes e.g. what is
diabetes, complications (culturally
tailored diabetes education
Culturally tailored dietary advice e.g.
traditional foods and cooking methods
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 34 of 90
Date: 26/01/11
Review Date: 27/01/11
programmes delivered locally)
Culturally tailored options for physical
activity
Information about diabetes
medications and Chinese herbal
remedies
Culturally tailored dietary advice and
information about traditional foods
Information about the diabetes
healthcare team and diabetes services
Support to cope with looking after an
elderly person with diabetes e.g.
nutritional support info, carer support
networks etc.
Diabetes medications – general plus
info about alternative medications,
fasting and medications, arranging
prescriptions for holidays
The risk of diabetes complications in
South Asian populations
Culturally tailored diabetes education
programmes (delivered locally)
Information about the diabetes
healthcare team and diabetes
services, as well as Diabetes UK
services and details of local Diabetes
UK voluntary group.
Information and advice about planning
for a pregnancy and pregnancy
Support to cope with diabetes e.g.
specialist help, carer support networks
etc.
Would you find getting a paper copy of
your care plan from your diabetes
healthcare team useful in helping you
manage your diabetes
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
The majority of participants felt they
would benefit from having a copy of
their diabetes care plan e.g. agreed
goals, progress report etc. However,
some participants reported that they
Version: 1
Page 35 of 90
The majority of participants felt they
would benefit from having a copy of
their diabetes care plan e.g. agreed
goals etc.
Date: 26/01/11
Review Date: 27/01/11
could not read or write in any language
therefore verbal advice (? on tape)
would be more useful
Do you have a full review at least once
a year and at ongoing intervals
All participants reported to have had an
annual review. However, some
participant reported no ongoing review
despite poor control.
Physical examinations reported
included:
Weight and BMI – no participants were Weight and BMI – some participants
aware of ethnic specific targets (no one reported not to be aware of ethnic
had their waist circumference
specific targets
measured)
Legs and feet – all participants
Legs and feet – all participants
reported to have their skin, circulation
reported to have their skin, circulation
and nerve supply checked
and nerve supply checked
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
All participants reported to have had
an annual review. However, some
participant reported no ongoing review
despite poor control, problems,
concerns etc.
Blood pressure - all participants
reported to have their blood pressure
checked. Some participants were
unsure regarding the target and
medication required.
Blood pressure - all participants
reported to have their blood pressure
checked. Some participants were
unsure regarding the target and
medication required.
Eyes (retina and vision) – all
participants reported to have their eyes
checked. However, some participants
were unsure about their results
Eyes (retina and vision) – all
participants reported to have their eyes
checked. However, some participants
were unsure about their results
Version: 1
Page 36 of 90
Date: 26/01/11
Review Date: 27/01/11
Blood and urine tests reported
included:
Your injection sites – all participants on
insulin reported to have these
examined.
Your injection sites – all participants on
insulin reported to have these
examined.
Blood glucose control: HbA1c
Kidney function: Urine and blood tests
(eGFR)
Blood fats (including cholesterol)
Blood glucose control: HbA1c
Kidney function: Urine and blood tests
(eGFR)
Blood fats (including cholesterol)
However, a number of participants
reported to be unsure regarding which
tests they had provided blood samples
for, reasons for these tests and results
obtained.
However, a number of participants
reported to be unsure regarding which
tests they had provided blood samples
for, reasons for the tests and results
obtained.
What care do you expect from your diabetes healthcare team?
Table 16: Views of Chinese and Pakistani patients with diabetes about what care to expect from their healthcare
team
When you were first diagnosed with
diabetes, did you have a medical
examination and discussion with a
member of your diabetes healthcare
team?
Chinese patients with type 2
diabetes
All participants reported to have had
immediate treatment and any
unanswered questions addressed.
However, some participants reported
they were not asked about their
concerns or feeling about their new
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 37 of 90
Pakistani patients with type 2 diabetes
All participants reported to have had
immediate treatment and any unanswered
questions addressed. However, some
participants reported they were not asked
about their concerns or feeling about their
new diagnosis e.g.
Date: 26/01/11
Review Date: 27/01/11
diagnosis e.g.
“why me”
“fear of death”
“punishment for God”
“I didn‟t understand why I had
diabetes. No one asked me how I
felt about being diagnosed with
diabetes. I was scared”
When you were first diagnosed with
diabetes, did you receive an
explanation of what is on offer for you
to learn more about diabetes and
keeping well?
All participants reported to have seen
their GP and nurse and been given
information about diabetes and
keeping well (however, this
information was not culturally tailored
therefore difficult to make important
dietary changes).
All participants reported to have seen their
GP and nurse and been given information
about diabetes and keeping well
(however, this information was not
culturally tailored therefore difficult to
make important diet and lifestyle
changes).
No participants reported to have
been informed about any diabetes
education programmes or other
sources of information and support.
No participants reported to have been
informed about any diabetes education
programmes or other sources of
information and support
When you were first diagnosed with
diabetes, did you see a registered
dietitian?
No participants reported to have
seen a dietitian to discuss their diet.
However, all participants felt they
would have benefited for culturally
tailored dietary advice to help
manage diabetes.
Very few participants reported to have
seen a dietitian to discuss their diet.
However, all participants felt they would
have benefited for culturally tailored
dietary advice to help manage diabetes
Once you received initial information
and treatment, what did your ongoing
care include?
An annual review with a doctor or
nurse experienced in diabetes
An annual review with a doctor or nurse
experienced in diabetes
An eyesight test once a year
An eyesight test once a year
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 38 of 90
Date: 26/01/11
Review Date: 27/01/11
Very few participants reported to
have regular access to their diabetes
healthcare team to assess their
diabetes control e.g. 6 monthly etc.
However, participants felt they would
benefit from specific support and
advice from healthcare professionals
when they need it.
As part of your ongoing care, what
support did you receive from your
diabetes healthcare team to help you
to manage your diabetes?
Very few participants reported to have
regular access to their diabetes healthcare
team to assess their diabetes control e.g.
6 monthly etc. However, participants felt
they would benefit from specific support
and advice from healthcare professionals
when they need it.
Continuity of care – “I always go back Continuity of care – “experienced diabetes
to the same doctor about my
doctors and nurses were aware of my
diabetes”
medical history and background”
Patient and practitioner relationship –
“they look after me”, “he understands
me”, “i trust her”
Patient and practitioner relationship –
“worked together to decide diabetes goals”
Information about the management
and treatment of diabetes – “I don‟t
always understand what I‟ve been
asked to do”
Information about the management and
treatment of diabetes
Access to specialist services e.g. podiatry,
retinal screening, interpretation etc
Access to specialist services e.g.
podiatry, retinal screening,
interpretation etc
As part of your ongoing care, what
support would you have liked to
receive from your diabetes
healthcare team to help you to
Help to understand information e.g.
time with interpreters to read through
the information leaflets in order to
ask healthcare professional
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 39 of 90
Help to understand information to ensure
involvement in decisions about care e.g.
access to results with information about
what they mean
Date: 26/01/11
Review Date: 27/01/11
manage your diabetes?
appropriate questions
More involvement in decisions
making e.g. access to results with
information about what they mean
“so as I can help make a plan for my
to follow”
Discussions around feelings, concerns
etc. supported with information about what
emotional and psychological support is
available locally
Pre- and post-pregnancy advice
Discussions around feelings,
concerns etc. supported with
information about what support is
available locally
Education sessions, appointments and
information on different ways you can
learn about diabetes (including
management and treatment)
Education sessions, appointments
and information on different ways you
can learn about diabetes (including
what is diabetes, management and
treatment)
Review of medicines which may be via the
pharmacist
Review of medicines which may be
via the pharmacist
Information about testing blood at
home and a discussion of what the
results mean and what to do about
them
Information about testing blood at home
and a discussion of what the results mean
and what to do about them
A discussion about hypoglycaemia
(hypos) episodes, when and why they may
happen and how to deal with them
A discussion about hypoglycaemia
(hypos) episodes, when and why
they may happen and how to deal
with them
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 40 of 90
Date: 26/01/11
Review Date: 27/01/11
Your role in looking after your diabetes
Table 17: Your role in looking after your diabetes
Chinese patients with type 2
diabetes
The majority of participants were
aware they had a role to play in looking
after their diabetes which involved diet,
physical activity, taking medications /
insulin, monitoring blood glucose
levels.
Pakistani patients with type 2
diabetes
The majority of participants were
aware they had a role to play in
managing their diabetes which
involved diet, physical activity, taking
medications / insulin, monitoring blood
glucose levels.
Do you give accurate information about The majority of participants reported to
your health and how you are feeling?
give accurate information about their
health but did not discuss how they
were feeling
The majority of participants reported to
give accurate information about their
health and how they are feeling.
However, some participants reported
not to mention any problems esp. if
their diabetes control is poor due to a
fear of needing more medications or
being converted onto insulin.
Do you put into everyday practice the
goals you may have agreed in your
care plan about healthy eating,
physical activity, taking your
medication and monitoring your blood
glucose levels?
The majority of participants reported to
put into practice the goals about
healthy eating, physical activity, taking
your medication and monitoring your
blood glucose levels. However, many
participants reported not to adhere to
advice due to a lack of understanding
of the information provided e.g. not
Do you recognise your role in your
health and take some personal
responsibility for managing it day-today?
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
The majority of participants reported to
put into practice the goals about
healthy eating, physical activity, taking
your medication and monitoring your
blood glucose levels. However, many
participants reported not to adhere to
advice due to a lack of understanding
of the information provided e.g. not
Version: 1
Page 41 of 90
Date: 26/01/11
Review Date: 27/01/11
culturally specific
culturally specific
Do you examine your feet regularly
between reviews?
The majority of participants reported to
examine their feet regularly between
reviews (if they were unable they
asked someone else to check them for
them)
The majority of participants reported to
examine their feet regularly between
reviews (if you are unable they asked
someone else to check them for them)
Do you know how to manage your
diabetes and when to ask for help if
you are ill, for example if you have
diarrhoea and are vomiting?
The majority of participants would ask
their GP or nurse for help if they were
unwell but did not know how to
manage their diabetes if they had
diarhhoea or vomiting
Do you know when, where and how to
contact your diabetes healthcare
team?
The majority of participants would ask
their GP or nurse for help if they were
unwell but did not know how to
manage their diabetes if they had
diarhhoea or vomiting (? Sick day
rules).
The majority of participants knew how
to contact their diabetes healthcare
team.
Do you attend your appointments or
rearrange them as soon as possible?
The majority of participants reported to
try and attend their appointments.
The majority of participants reported to
try and attend their appointments.
However, some people reported they
forgot their appointments (DNA) and
did not rearrange.
Do you make a list of points to raise at
your appointments?
The majority of participants did not
make a list of points to raise at their
appointments. However, some people
reported to find it helpful, asking
someone else to come with them for
support.
The majority of participants did not
make a list of points to raise at their
appointments. However, some
reported to find it helpful, asking
someone else to come with them for
support.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 42 of 90
The majority of participants knew how
to contact their diabetes healthcare
team
Date: 26/01/11
Review Date: 27/01/11
Do you carry some form of medical
identification about your diabetes?
The majority of participants did not
carry any medical identification about
their diabetes
The majority of participants did not
carry any medical identification about
their diabetes
Do you discuss with your diabetes
healthcare team if you are pregnant or
planning to become pregnant?
The majority of female participants
reported to have had their children
prior to being diagnosed with diabetes.
They did not realise pre- and post
pregnancy advice could be organised
with their obstetric team.
The majority of female participants did
not discuss with their diabetes
healthcare team if they were pregnant
or planning to become pregnant. They
did not realise pre- and post pregnancy
advice could be organised with their
obstetric team.
Do you give feedback to your
healthcare team about the treatment
and care you have received?
The majority of participant‟s reported
not to give any feedback to their
healthcare team about the treatment
and care they received. They reported
not to realise that their views would be
important to improve service delivery.
However, they would be keen to
provide their views if they were
informed of the process involved
The majority of participant‟s reported
not to give any feedback to their
healthcare team about the treatment
and care they received. They reported
not to realise that their views would be
important to improve service delivery.
However, they would be keen to
provide their views if they were
informed of the process involved.
Do you treat NHS staff with respect?
The majority of participants reported to
treat NHS staff with respect.
The majority of participants reported to
treat NHS staff with respect.
“It is our culture and upbringing to treat
everyone with respect”
“They are helping us to stay healthy”
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 43 of 90
Date: 26/01/11
Review Date: 27/01/11
What support do you think you may
need from other people?
Involve family and friends in my
diabetes care e.g. to talk about
feelings, management e.g. making
meals, giving me medications, support
e.g. come along to appointments
Try to get to know other people with
diabetes – to talk about experiences
and feelings with others
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 44 of 90
Support from family and friends as
they could help me look after my
diabetes e.g. helping with your
medication or meals
Learn from other people in the
community about diabetes
Date: 26/01/11
Review Date: 27/01/11
Focus group with interpreters
The focus group consisted of 7 participants; the Head of NHS Fife Interpreting
and Translation Services, 3 Chinese interpreters and 3 Pakistani interpreters.
The group discussed issues around current workload, ethnic data recording,
specialist resources, problems encountered, culturally competent services and
professional education and training.
Interpreters’ current workload
All 3 Pakistani interpreters reported to interpret mainly for patients from Pakistan
and Punjab with diabetes. However, occasionally they provided interpreting
services for asylum seekers and refugees e.g. patients from Afghanistan with
diabetes and migrant workers e.g. patients from Karachi with diabetes
All 3 Chinese interpreters reported to interpret for mainly Chinese patients with
diabetes. However, occasionally they provided interpreting services for migrant
workers e.g. patients from China with diabetes
All interpreters reported to mostly spend enough time with their patients however,
sometimes more “too much” time was required due to the following factors:







“extra time needed to book appointments for patients”
“patients don‟t know they need to book double appointments”
“extra time spent if patient or clinic is running late”
“patients often ask about other problems”
“takes time to explain” – esp. with older patients
“patients or family members often ask me to explain what the doctor told
them at the end of their appointment”
“patients sometimes have unrealistic expectation of interpreters”
Ethnic data recording
All interpreters reported not to record any data about ethnicity. However, the
information provided to them in the form of a referral was vital to their role. It was
highlighted on several occasions there is an urgent need to improve the
information contained in a referral. The following areas were suggested:


Accurate recording of Chinese and South Asian patient names (based on
a better understanding of the traditional naming systems)
A note of the Chinese or South Asian patients preferred spoken language
and ability to read a language (information about the individual dialect
would be helpful)
Author: Chanda Bhogaita
Fife Diabetes MCN HNA
Page 45 of 90
Version: 1
Review Date: 27/01/11
Date: 26/01/11
Specialist resources
The majority of interpreters were not aware of resources available in different
languages for Chinese or South Asian patients with diabetes.
The majority of interpreters felt that having written information available for
patients in “their own language would help patients look after themselves”
The majority of interpreters felt that if they could go through the written
information with the patient this would “help the patient to understand what they
need to do”.
Some interpreters felt they should receive referrals to interpret written information
sent to patients in the post e.g. information sent to newly diagnosed diabetes
patients re diet etc.
o “reduce fear, anxiety and stress”
o “reduce dependence on family members and others”
o “help them to start making changes and take control”
The majority of interpreters felt that additional resources were required for
Chinese and South Asian patients with diabetes however, emphasized the need
for culturally specific information e.g. diet, pregnancy, insulin and medications,
herbal remedies, diabetes prevention, fasting (SA), travel, physical activity and
general diabetes information.
The majority of interpreters felt practical sessions would be more useful to help
patients make changes e.g. cooking, physical activity etc.
The majority of interpreters felt patients should receive information about the role
of the interpreter “to help establish a clear professional relationship”
Problems encountered
The majority of interpreters had encountered problems when working with
Chinese or South Asian patients with diabetes. Some of the problems
encountered included:
o
o
o
o
o
o
“patients expecting too much”
“healthcare practitioners giving us extra tasks”
“some patients had no explanation of their appointment”
“some patients or families don‟t want an interpreter”
“some people book interpreters then don‟t use them”
“difficulty booking patient appointments through the triage service”
Author: Chanda Bhogaita
Fife Diabetes MCN HNA
Page 46 of 90
Version: 1
Review Date: 27/01/11
Date: 26/01/11
Culturally competent services
Interpreters reported to consider factors such as cultural sensitivities, patient‟s
spoken language and reading ability, need for information resources and issues
around their role as an interpreter when providing services to Chinese or South
Asian patients with diabetes.
They mentioned healthcare professionals they had worked with consider factors
such as need for an interpreter, patient‟s spoken language, dietary issues – “not
culturally specific”, lifestyle issues – “not culturally specific” and the need for
information resources – “not in the appropriate language” when providing
services to Chinese and South Asian patients with diabetes.
Some interpreters felt healthcare professional did not ask culturally specific
questions esp. around ethnicity, religion, diet e.g. halal, preferred gender of
healthcare professional patients would like to be seen by, use of herbal and
traditional remedies e.g. karela, ayurvedic, Chinese etc.
Professional education and training
Some interpreters felt healthcare professionals did not ask questions in a way
they found easy to interpret (esp. technical terminology) therefore their
explanations to clients took longer which seemed to make healthcare
professionals “suspicious” of what was being interpreted to patients. All
interpreters felt that they would have benefited from a quick discussion with the
healthcare professional to explain the style of the consultation prior to seeing the
patient.
The majority of interpreters had not received any training about delivering
culturally competent services for Chinese or South Asian patients with diabetes.
The majority of interpreters felt they would benefit from training to help provide
culturally competent services for Chinese or South Asian patients with diabetes.
Training they felt they required to deliver culturally competent services for
Chinese or South Asian patients with diabetes included:





The terminology used in relation to diabetes e.g. basal bolus,
carbohydrate etc.
Communication skills e.g. healthcare professionals style of patient
interview
Group working skills e.g. education sessions, talks etc
Awareness of diabetes information resources available in different
languages
What to do if a client is having a hypo
Author: Chanda Bhogaita
Fife Diabetes MCN HNA
Page 47 of 90
Version: 1
Review Date: 27/01/11
Date: 26/01/11
Questionnaires for healthcare professionals
104 questionnaires were distributed and 43 responses were received, giving a
response rate of 41.3%. Table 18 below shows the number of responses
received from each type of healthcare professional group with a specialist
interest in diabetes.
Table 18: Questionnaire responses from diabetes specialist staff
Healthcare professionals
Number of responses
Primary care staffs
(general practitioner and practice nurse)
Acute medical staffs
(consultant physician/ diabetologist)
Diabetes specialist nurse
Diabetes specialist dietitian
Diabetes specialist podiatrist
Diabetes retinal screening service staffs
(ophthalmologist and screeners)
Psychologist
Pharmacist
Total
20 (46.5%)
2 (4.65%)
3 (7%)
7 (16.3%)
3 (7%)
5 (11.6%)
1(2.3%)
2 (4.65%)
43 (100%)
Table 19 below establishes that the majority of responses came from healthcare
professionals working in Kirkcaldy and Levenmouth CHP, followed by Dunfemline
and West Fife CHP and Glenrothes and North East Fife, Victoria Hospital
Kirkcaldy, Queen Margaret Hospital and then Forth Park Hospital.
Table 19: Proportion of HCPs working in each CHP and/or Operational Division
HCPs
D&WF
CHP
G&NEF
CHP
K&L
CHP
VHK
QMH
Forth
Park
Hospital
25.0%
14.7%
30.9%
14.7%
10.3%
4.4%
Total
100%
Tables 20 to 32 show the responses received for each section of the
questionnaire
.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 48 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 20 below identifies that healthcare professionals are managing BME
patients from primarily South Asian followed by Chinese and then Migrant worker
e.g. Polish backgrounds.
Table 20: Proportion of HPCs managing BME patients
BME community
South Asian
Black African/Caribbean
Chinese
Asylum Seekers &Refugees
Migrant Workers e.g. Polish
Gypsies/Travellers
HCPs managing BME patients
Yes
83.3%
42.9%
66.7%
14.3%
57.1%
28.6%
No
16.7%
57.1%
33.3%
85.7%
42.9%
71.4%
However, 39.5% of healthcare professionals reported that they did not spend
enough time with their BME patients in order to provide culturally competent
services.
Table 21 below indicates that healthcare professionals are recording ethnicity
data more routinely compared to cultural data (with the exception of language
spoken). However, the recording of both ethnicity and cultural data is low.
Table 21: Recording of ethnicity and cultural data by HCPs
Ethnicity and cultural data
Ethnicity
Language spoken
Language read
Religion
Diet e.g. vegetarian, halal etc.
Preferred gender of healthcare
professional patient would like to be
seen by
Use of herbal and traditional remedies
e.g. karela, ayurvedic, Chinese etc
HCPs recording data
Yes
53.8%
51.3%
30.8%
20.5%
35.9%
7.7%
No
46.2%
48.7%
69.2%
79.5%
64.1%
92.3%
20.5%
79.5%
73.9% of healthcare professionals reported to record ethnicity data electronically
however, their recording of cultural data was variable, electronically or on paper.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 49 of 90
Date: 26/01/11
Review Date: 27/01/11
Tables 22 and 23 below reveal that healthcare professionals were mostly aware
of the Diabetes UK booklets and information sheets about healthy living with
Diabetes available in different languages for BME patients with Diabetes.
Table 22: HPCs awareness of Diabetes UK booklets about healthy living with
diabetes
Diabetes UK booklets
Living Healthily with Diabetes – A guide
for Black African-Caribbean
Communities (available in English)
Healthy Eating for the South Asian
Community (available in English,
Bengali, Gujarati, Hindi, Punjabi &
Urdu)
HPC awareness of resource
Yes
63.2%
No
36.8%
60.5%
39.5%
Table 23: HPCs awareness of Diabetes UK information sheets about living with
diabetes
Diabetes UK information sheets
What is diabetes
Managing diabetes
Healthy lifestyle, fasting & diabetes
Ramadan & diabetes
Hypoglycaemia
Diabetic Complications
How Diabetes UK can help you
HPC awareness of resource
Yes
89.5%
86.8%
68.4%
60.5%
68.4%
65.8%
71.1%
No
10.5%
13.2%
31.6%
39.5%
31.6%
34.2%
28.9%
However, relatively few healthcare professional had used these resources.
About one third of respondents had used „Healthy Eating for the South Asian
Community‟ however, only 13.9% of respondents had used „Living Healthily with
Diabetes – A guide for Black African-Caribbean Communities‟. Less than one
third of respondents had used „What is diabetes‟ and „Managing diabetes‟, a
quarter had used „Healthy lifestyle, fasting and diabetes‟, about a fifth had used
„Ramadan and diabetes‟ and 13.9% had used „Diabetic complications‟ and „How
Diabetes UK can help you‟.
Tables 24 and 25 below reveal that healthcare professionals were mostly
unaware of the Diabetes UK information sheets about coping with Diabetes and
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 50 of 90
Date: 26/01/11
Review Date: 27/01/11
the DVD raising awareness of Diabetes available in different languages for BME
patients with Diabetes.
Table 24: HCPs awareness of Diabetes UK information sheets about coping with
Diabetes
.
Diabetes UK information sheets
HPC awareness of resource
Cardiovascular & kidney disease
Your eyes and diabetes
Nerve damage & diabetes
Pregnancy & diabetes
Yes
39.5%
36.8%
36.8%
44.7%
No
60.5%
63.2%
63.2%
55.3%
Table 25: HCPs awareness of Diabetes UK DVD raising awareness of Diabetes
Diabetes UK DVD
HPC awareness of resource
Meethi Baatein/Sweet Talk
Yes
18.4%
No
81.6%
Unsurprisingly, relatively few healthcare professional had used these resources.
Less than one fifth of respondents had used „Pregnancy and diabetes‟, 11.1%
had used „Cardiovascular & Kidney Disease‟, „Your eyes and diabetes‟ and
„Nerve damage & diabetes‟. Only 8.3% of respondents had used the Diabetes UK
DVD.
Table 26 below identified that healthcare professionals expressed a greater need
for a range of additional resources especially for South Asian followed by Migrant
workers e.g. Polish, Black African/Caribbean and Chinese patients with diabetes
and to a lesser extent for Gypsies/Travellers and Asylum Seekers & Refugees.
Table 26: Additional resources HPCs require for BME patients
Diabetes
Prevention
Type 1
Diabetes
Type 2
Diabetes
South
Asian
Black
African/
Caribbean
Chinese
Asylum
Seekers &
Refugees
Migrant
Workers
(eg Polish)
Gypsies/
Travellers
92.3%
38.5%
38.5%
7.7%
30.8%
7.7%
60.0%
40.0%
20.0%
0.0%
60.0%
20.0%
88.9%
44.4%
33.3%
11.1%
33.3%
22.2%
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 51 of 90
Date: 26/01/11
Review Date: 27/01/11
Healthy
Lifestyle
Fasting
Herbal
Remedies
Travel
Short term
complicatio
ns
Long term
complicatio
ns
Prepregnancy
/Pregnancy
Insulin &
Medications
80.0%
40.0%
30.0%
10.0%
50.0%
20.0%
100.0
%
75.0%
22.2%
11.1%
0.0%
0.0%
0.0%
0.0%
25.0%
0.0%
0.0%
0.0%
100.0
%
87.5%
40.0%
20.0%
0.0%
20.0%
0.0%
25.0%
25.0%
0.0%
37.5%
0.0%
88.9%
33.3%
22.2%
11.1%
44.4%
11.0%
80.0%
40.0%
40.0%
0.0%
60.0%
20.0%
100.0
%
55.6%
33.3%
0.0%
22.2%
0.0%
Additional information provided about resources required included:





National leaflets in several languages for BME patients with diabetes
An online resource to download BME patient information leaflets
Practical information about the use of blood glucose meters
Specialist type 1 carbohydrate counting information
Appointment letters in South Asian languages
Table 27 below reveals that healthcare professionals encounter significantly
more problems when working with South Asian patients with diabetes compared
to any other BME group.
Table 27: Problems encountered by HPCs when working with BME patients
BME communities
South Asian
Black African/Caribbean
Chinese
Asylum Seekers & Refugees
Migrant Workers e.g. Polish
Gypsies/Travellers
Problems encountered by HCPs
Yes
70.6%
20.6%
44.1%
14.7%
38.2%
11.8%
No
29.4%
79.4%
55.9%
85.3%
61.8%
88.2%
Table 28 below described the types of problems healthcare professionals
enountered when working with BME patients with diabetes. The highest
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 52 of 90
Date: 26/01/11
Review Date: 27/01/11
proportion of problems were experienced due to communication difficulties,
followed by poor self management skills and adherence to prescribed
medications, then dietary and lifestyle issues. Problems associated with cultural
and religious issues appeared to be encountered less often.
Table 28: Types of problems HPCs encounter when working with BME patients
Problems
Problems encountered by HCPs
Communications difficulties
Cultural and religious issues
Dietary Issues
Lifestyle Issues
Poor adherence to prescribed
medication
Poor Self Management Skills
Yes
76.5%
33.3%
63.6%
60.6%
70.6%
No
23.5%
66.7%
36.4%
39.4%
29.4%
70.6%
29.4%
Additional information provided about the problems encountered included:
 Extended vacations overseas, difficulties with continuity of care
 Poor attendance to clinics, especially review appointments
“Non attendance by polish patient, uses A+E as drop in centre”
 Inappropriate interpretation arrangements
 Lack of appropriate patient resources and educational programmes
 Health beliefs against any medication
 Poor level of practitioner knowledge
“I find it difficult to engage with a patient as she comes in with a different
member of her family to interpret at each consultation. I am not clear how
to advise re diet and exercise. However she is generally well controlled
with her diabetes. I am not sure how to support her self management”
Table 29 below suggests that the majority of healthcare professionals are
considering relevant cultural factors when providing services to BME patients
with diabetes. However, consideration of local sources of information and support
of BME patients appears to receive less focus.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 53 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 29: Cultural factors HPCs consider when providing services to BME
patients
Cultural factors
% HPCs who consider
cultural factor
Cultural sensitivities
Need for an interpreter
Patients reading ability (in English or own language)
Need for education
Need for info resources
Dietary issues
Lifestyle issues
Awareness of local sources of information/support for
patients
Awareness of Diabetes UK‟s free language materials
83.3%
86.7%
83.3%
80.0%
73.3%
83.3%
83.3%
66.7%
86.7%
Table 30 below shows that healthcare professionals have had very little training
about delivering culturally competent services for BME patients with diabetes.
Table 30: Cultural competence training for HPCs
BME communities
South Asian
Black African/Caribbean
Chinese
Asylum Seekers & Refugees
Migrant Workers e.g. Polish
Gypsies/Travellers
Training received by HCPs
Yes
18.8%
6.3%
3.3%
6.3%
6.3%
3.1%
No
81.3%
93.8%
96.9%
93.8%
93.8%
96.9%
Only 35.3% of respondents felt that the training they had received helped them to
provide culturally competent services for BME patients.
Additional information provided about the training healthcare professionals
received included:


Most training has been provided by NHS Fife, FRAE Fife and a study day
on travellers delivered by travelers with varying degrees of satisfaction
In service Nutrition and Dietetic department training “Introduction to the
cultural, religious and dietary practices in South Asians” was well received
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 54 of 90
Date: 26/01/11
Review Date: 27/01/11
Table 31 states that healthcare professionals would like training to help them
provide culturally competent services for South Asian patients with diabetes.
Table 31: HPCs training needs in relation to BME patients
BME communities
South Asian
Black African/Caribbean
Chinese
Asylum Seekers & Refugees
Migrant Workers e.g. Polish
Gypsies/Travellers
Training need expressed by HCPs
Yes
75.0%
33.3%
20.0%
20.0%
20.0%
20.0%
No
25.0%
66.7%
80.0%
80.0%
80.0%
80.0%
Table 32 describes what specific cultural topics healthcare professionals would
like to receive training about in order to help them deliver culturally competent
services for BME patients with diabetes.
Table 32: HCPs training needs in relation to cultural topics
Cultural topic
HPCs Response
Cultural and religious diversity
Communication skills e.g. using interpreters
BME diabetes patient education programmes
BME diabetes specialist information resources
Dietary issues
Lifestyle issues
Ethnic specific values for BMI and waist circumferences
Awareness of local sources of information and support
for patients
64.0%
44.0%
72.0%
76.0%
76.0%
76.0%
52.0%
96.0%
Additional information provided about training needs included:



Training regarding all of the areas listed in the table above
A list of local sources of information and patient support available
A 1/2 day training or PLT session
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 55 of 90
Date: 26/01/11
Review Date: 27/01/11
10.0 Key findings
There is limited data about BME populations living in Fife to allow in-depth
analysis of specific issues relating to diabetes or breakdowns into ethnic groups.
Sub-optimal ethnicity and cultural data recording makes it difficult to accurately
assess the number of BME patients and their needs for diabetes services. It is
estimated that 664 BME people in Fife have diabetes, the majority of who are of
South Asian descent.
Analysis of patient records reveals poorer diabetes clinical outcomes for
Pakistani patients with type 2 diabetes compared to the total Fife population.
Significant differences in the levels of obesity, glycaemic control and combined
targets for blood glucose, blood pressure and cholesterol may be attributable to
environmental factors, genetic aspects and underlying health inequalities.
Systematic review of national policy and best practice guidelines recommends
the delivery of culturally competent care and education for BME patients with
diabetes. In order to improve knowledge and diabetes control a service model
based on delivering mainstream clinics and community educational programmes
using bilingual healthcare professionals and link workers is the favoured
approach.
NHS Fife scoping exercises determine that the care and education of BME
patients is provided as part of mainstream diabetes services. The current service
model is delivered using interpreters, culturally sensitive resources and various
educational programmes piloted in local BME groups. A lack of adequate
resource, staffing and funding means that there is a very little capacity to improve
integration with mainstream diabetes services and meet the needs of BME
patients.
BME patient focus groups highlight the need for culturally competent care and
education with appropriate language support. The majority of BME patients feel
that diabetes healthcare teams are meeting their expectations of care. However,
they detect a lack of cultural awareness and appropriate resources among
healthcare professionals which impacts negatively on the quality of education
they receive. BME patients would like the opportunity to contribute to wider
discussions around service planning and resources allocation.
Interpreter focus groups emphasise the lack of cultural awareness, resources
and appropriate use of their expertise among healthcare professionals. The
majority of interpreters would like training to facilitate better communication
between healthcare professionals and BME patients with diabetes.
Healthcare professional questionnaire results acknowledge the importance of
providing culturally competent diabetes care and education for BME patients with
diabetes. They are keen to address problems with communication and cultural
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 56 of 90
Date: 26/01/11
Review Date: 27/01/11
issues in order to improve self management skills in BME patients. Most
healthcare professionals expressed a need for training (in proportion to the size
of their BME workload) to deliver culturally competent services for BME patients.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 57 of 90
Date: 26/01/11
Review Date: 27/01/11
11.0 Conclusion
The relatively small BME population and disperse geographical distribution has
implications on how diabetes services can be equitably delivered in NHS Fife.
Currently culturally sensitive care and education is being provided as part of
mainstream diabetes services however, there is scope for improvement. Key
themes that could be considered are as follows:



Internal policies and procedures
Healthcare staff training and information needs
BME patients care, education, information and support needs
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 58 of 90
Date: 26/01/11
Review Date: 27/01/11
12.0 Recommendations
This health needs assessment has identified the following recommendations:
Services and Procedures

Improve the recording of ethnicity and cultural data using the Scottish
Census 2011 ethnic classifications and National Resource Centre for
Ethnic Minority Health ethnic monitoring toolkit for guidance.54

Generate data about the diabetes clinical outcomes in BME groups to
compare with the total Fife population, in partnership with EMIS, Vision
and SCI-DC.

Explore options for permanent funding to support diabetes services to
develop a sustainable service model linked as closely to mainstream
services as possible to ensure that BME patients receive culturally
sensitive and language appropriate diabetes care and education.
BME patients care, education, information and support needs

Establish clear lines of communication with local BME groups to identify
needs and support access to culturally sensitive mainstream diabetes
services, in partnership with Patient Focus and Public Involvement.

Design a referral pathway to identify BME patients suitable for culturally
sensitive educational programmes delivered by a healthcare professional
with an interpreter (if required), trained BME health link worker or bilingual
healthcare professional.

Provide information about resources, local services and health initiatives
using effective communication methods i.e. websites (e.g. Health in my
Language, Diabetes UK), Frae Fife, BME communities or faith groups
(accessed via PFPI Leads to Equalities Participation Network in Fife),
interpreters and translation service in specific instances.
Healthcare staff training and information needs

Ensure staff undertake Equality and Diversity training and access further
on-line modules to deliver culturally competent practice. Raise awareness
of the appropriate use of interpreting services.

The Fife Interpreting Service in line with the NHS Scotland Competency
Framework for Interpreting, will ensure appropriate subject knowledge and
language competence, and this will be supported by healthcare staff as
required and or requested
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 59 of 90
Date: 26/01/11
Review Date: 27/01/11

Develop a web page on the intranet together with the three community
health care partnerships with information about BME information
resources including (but not limited to);
 local sources of support (Equalities Participation Network in Fife),
literature produced by the National Resource Centre for Ethnic
Minority Health (NRCEMH)
 “NHS Fife Diabetes Handbook” updated to include a chapter on
the management of BME patients with diabetes.
 National Occupational Standards in Interpreting developed by the
National Centre for Languages (www.cilt.org.uk)
 Health in my language (www.healthinmylanguage.com)
 NHS Scotland Competency Framework for Interpreting
(www.healthscotland.com)
Future research and funding
Given the lack of representation of certain BME groups in this report, NHS Fife
needs to give a firm commitment to continuing the work started, by providing
dedicated hours for co-coordinating similar work to assess the health needs
across different BME communities in line with the Diabetes Action Plan 2010.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 60 of 90
Date: 26/01/11
Review Date: 27/01/11
Action Plan
Recommendation
Action
Responsibility
Ethnic recording
Explore routes for improving recording of ethnicity
Collating clinical outcomes
Using clinical information systems to collect and collate
meaningful data from BME patients to compare with the total
population
Explore funding options and work collaboratively to provide a
service model for BME patients which is linked to mainstream
services while providing culturally sensitive and language
appropriate diabetes care.
MCN
SCI-DC/DRS
Diabetes Information
Management and Technology
(DIMT) Subgroup
CHPs
DSNs
MCN
Services and Procedures
Develop a sustainable service model
for BME patients
BME patients’ care, education, information and support needs
Communication with local BME Groups
Improve and or establish lines of communication with local BME
groups to identify and address needs in partnership with PFPI.
Referral to educational programmes
Develop a pathway and provide culturally sensitive educational
programmes with an interpreter and or bilingual healthcare
professional
Provide information on local services in appropriate formats and
language.
Provision of information resources
PFPI
Equality and Diversity (E&Q)
MCN
Equality and Diversity
Interpreting Service
MCN
Frae Fife
E&Q
Healthcare staff training and information needs
Training to deliver a culturally
competent service
Training for interpreters
Web page
Address wider issues of racism, cultural practices and health
needs, and ensure access to appropriate training
Address issues of medical terminology, style of consultations
and options to deliver group education sessions.
Develop a web page containing information for BME patients
with diabetes
E&Q
Interpreting Service
Interpreting Service
Continue work in line with the Diabetes Action Plan 2010 to
address the health needs of different BME communities.
E&Q
MCN
DIMT Subgroup
Web/Intranet Team
Future research and funding
Continue work with BME Groups
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 61 of 90
Date: 26/01/11
Review Date: 27/01/11
References
1.
International Diabetes Federation. The Diabetes Atlas.
http://www.diabetesatlas.org/content/global-burden (accessed 15 March 2011)
2. Diabetes UK. Reports and statistics. Diabetes prevalence 2010.
http://www.diabetes.org.uk/Professionals/Publications-reports-andresources/Reports-statistics-and-case-studies/Reports/Diabetesprevalence-2010/ (accessed 15 March 2011)
3. Scottish Diabetes Survey Monitoring Group. Scottish Diabetes Survey
2009. Diabetes in Scotland, 2010
4.
Scottish Public Health Observatory. Diabetes: key points.
http://www.scotpho.org.uk/home/Healthwellbeinganddisease/Diabetes/diabetes_keypoints.asp (accessed 15 March 2011)
5. Khunti K, Kumar S and Brodie J. Diabetes UK and South Asian Health
Foundation recommendations on diabetes research priorities for British
South Asians. Diabetes UK. First edition, 2009
6. National Resource Centre for Ethnic Minority Health and Diabetes UK.
Focus on Diabetes: A guide to working with black and minority ethnic
communities in Scotland living with long term conditions. NHS Health
Scotland, 2007
7. Mather HM, Keen H. Southall Diabetes Survey: prevalence of known
diabetes. BMJ1985; 291: 1081–1084
8. Riste L, Khan F, Cruickshank K. High prevalence of Type 2 diabetes in all
ethnic groups, including Europeans in a British Inner City. Relative
poverty, history, inactivity or 21st century Europe? Diabetes Care 2001;
24: 1377–1383
9. Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes
in South Asians and Europeans: 11 year follow-up of the Southall
Diabetes Survey, London, UK. Diabetic Medicine1998; 15: 53–59
10. O‟Hare JP, Raymond NT, Mughal S et al. Evaluation of delivery of
enhanced diabetes care to patients of South Asian ethnicity: The United
Kingdom Asian Diabetes Study (UKADS). Diabetes Medicine 2004;
21(12): 1357-1365
11. Hawthorne K. Effect of culturally appropriate health education on
glycaemic control and knowledge of diabetes in British Pakistani women
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 62 of 90
Date: 26/01/11
Review Date: 27/01/11
with Type 2 Diabetes Mellitus. Health Education Research 2001; 16(3):
373-381
12. Hawthorne K. Accessibility and use of health care services in British Asian
community. Family Practice 1994; 11: 453–459
13.
Scottish Executive. Fair For All. 2001
http://www.scotland.gov.uk/Resource/Doc/159176/0043303.pdf (accessed
15 March 2011)
14.
The National Archives. Race Relations (Amendment) Act 2000.
http://www.legislation.gov.uk/ukpga/2000/34/contents (accessed 15 March
2011)
15. NHS Fife. Race Equality Scheme 2008-2011. 2002
http://www.nhsfife.scot.nhs.uk/DIVERSITY&EQUALITY/Race%20Equality
%20Scheme%202008-2011.doc.pdf (accessed 15 March 2011)
16.
Cavanagh S, Chadwick K. Health needs assessment: A practical guide.
National Institute of Clinical Excellence, 2005
http://www.nice.org.uk/media/150/35/Health_Needs_Assessment_A_Pract
ical_Guide.pdf (accessed 15 March 2011)
17.
SCROL. Scottish census results online. 2001
http://www.scrol.gov.uk/scrol/common/home.jsp (accessed 15 March 2011)
18. National Statistics. Health Survey for England 2004: health of ethnic
minorities. Volume 1
http://www.ic.nhs.uk/webfiles/publications/healthsurvey2004ethnicfull/Heal
thSurveyforEnglandVol1_210406_PDF.pdf (accessed 15 March 2011)
19. Simmons D, Williams DR, Powell MJ. The Coventry Diabetes Study:
prevalence of diabetes and impaired glucose tolerance in Europids and
Asians. Quarterly Journal of Medicine 199; 81(296): 1021–1030.
20. Unwin N, Alberti KG, Bhopal R et al. Comparison of the current WHO and
new ADA criteria for the diagnosis of diabetes mellitus in three
ethnic groups in the UK. American Diabetes Association. Diabetic
Medicine 1998; 15(7): 554–557
21. Riste L, Khan F, Cruickshank K. High prevalence of type 2 diabetes in all
ethnic groups, including Europeans, in a British inner city: relative poverty,
history, inactivity, or 21st century Europe? Diabetes Care 2001; 24(8):
1377–1383
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 63 of 90
Date: 26/01/11
Review Date: 27/01/11
22.
ERPHO. PBS Diabetes Prevalence Model Phase 3 - PCT single year
projections 2005-2010.
http://www.erpho.org.uk/viewResource.aspx?id=17841
(accessed 15 March 2011)
23. Sattar N, Glasgow University Study 2005, Journal of Diabetic Medicine
2006, cited in Sommerfield T. BME diabetes services in Lothian: a
healthcare needs assessment. NHS Lothian 2006
24. Wilkinson P, Sayer J, Laji K et al. Comparison of case fatality in south
Asian and white patients after acute myocardial infarction: observational
study. BMJ1996; 312(7042): 1330–1333
25. Joshi P, Islam S, Pais P et al. Risk factors for early myocardial infarction in
South Asians compared with individuals in other countries. Journal of the
American Medical Association 2007; 297(3): 286–294
26. Maher HM, Chaturvedi N, Fuller JH. Mortality and Morbidity from diabetes
in South Asians and Europeans: 11-year follow-up of the Southhall
Diabetes Survey, London, UK. Diabetic Medicine 1998; 15: 53–59.
27. Thomas I, Gupta S, Sempos C et al. Serum lipids of Indian physicians
living in the US compared to US-born physicians. Atherosclerosis 1986;
61(2): 99–106
28. Wild S, McKeigue P. Cross-sectional analysis of mortality by country of
birth in England and Wales, 1970–92. BMJ 1997; 8: 705–710
29. Gunarathne A, Patel JV, Potluri R et al. Increased 5-year mortality in the
migrant South Asian stroke patients with diabetes mellitus in the United
Kingdom: the West Birmingham Stroke Project. International Journal of
Clinical Practice 2008; 62 (2): 197–201
30. Raymond NT, Barnett AH, Varadhan L et al. Higher Prevalence of
Retinopathy in diabetic Patients of South Asian Ethnicity compared with
White Europeans in the Community. Diabetes Care 2009; 32(3): 410–415
31. Stratton IM, Kohner EM, Aldington SJ et al. UKPDS 50: Risk factors for
incidence and progression of retinopathy in Type 2 diabetes over 6 years
from diagnosis. Diabetologia 2001; 44: 156–163
32. Marshall SM. Recent advances in diabetic nephropathy. Postgraduate
Medical Journal 2004; 80(949): 624–633
33. Wu AY, Kong NC, de Leon FA et al. An alarmingly high prevalence of
diabetic nephropathy in Asian type 2 diabetic patients: the
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 64 of 90
Date: 26/01/11
Review Date: 27/01/11
MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 2005; 48(1): 17–
26
34. Bryson CL, Ross HJ, Boyko EJ et al. Racial and Ethnic Variations in
Albuminuria in the US Third National Health and Nutrition Examination
Survey (NHANES III) Population: Associations With Diabetes and Level of
CKD. American Journal of Kidney Diseases 2006; 48(5): 720–726
35. Parving HH, Lewis JB, Ravid M et al. Prevalence and risk factors for
microalbuminuria in a referred cohort of type II diabetic patients: a global
perspective. Kidney International 2006; 69(11): 2057–2063
36. Dreyer G, Hull S, Aitken Z et al. The effect of ethnicity on the prevalence
of diabetes and associated chronic kidney disease. Quarterly Journal of
Medicine 2009; 102(4): 261–269
37. GROS Census 2001 - reference volume, see Table Standard 201
www.gro-scotland.gov.uk/census/censushm/scotcen2/reports-anddata/scotcen6.html
38.
Scottish Executive. Analysis of Ethnicity in the 2001 Census. 2004.
www.scotland.gov.uk/publications/2004/02/18876/32937 (accessed 15 March
2011)
39.
Frae Fife. Fairness Race Awareness & Equality Fife
http://www.fraefife.co.uk/index.php?option=com_content&view=article&id=
25&Itemid=28&lang=es (accessed 15 March 2011)
40. Gordon D, Graham L, Robinson M et al. Dimensions of Diversity
Population differences and health improvement opportunities. NHS Health
Scotland. 2010
http://www.scotpho.org.uk/nmsruntime/saveasdialog.asp?IID=7380&sID=4
864 (accessed 16 March 2011)
41.
Scottish Government. NHS Scotland Quality Strategy - putting people at
the heart of our NHS. 2010
http://www.scotland.gov.uk/Publications/2010/05/10102307/0 (accessed 16
March 2011)
42.
Scottish Executive. Scottish Diabetes Framework. 2002
http://www.scotland.gov.uk/Publications/2002/04/14452/1980 (accessed 16
March 2011)
43.
Scottish Executive. Scottish Diabetes Framework: Action Plan. 2006
http://www.scotland.gov.uk/Publications/2006/06/12111211/0 (accessed 16
March 2011)
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 65 of 90
Date: 26/01/11
Review Date: 27/01/11
44.
Scottish Government. Better Health, Better Care: A Discussion Document.
2007 www.scotland.gov.uk/Resource/Doc/194854/0052337.pdf (accessed
15 March 2011)
45.
Scottish Government. The Diabetes Action Plan 2010: Quality Care for
Diabetes in Scotland. 2010.
http://www.scotland.gov.uk/Publications/2010/08/17095311/0 (accessed 16
March 2011)
46.
Scottish Intercollegiate Guidelines Network. Management of diabetes. A
national clinical guideline 116. 2010 http://www.sign.ac.uk/pdf/sign116.pdf
(assessed 16 March 2011)
47. Clinical Standards Board for Scotland. Diabetes Clinical Standards. 2002.
http://www.nhshealthquality.org/nhsgis/files/Diabetes%20Oct%202002.pdf
(accessed 16 March 2011)
48. Diabetes in Scotland. National Overview Follow-up Report. 2008
http://www.diabetesinscotland.org.uk/Publications/DIABETES_NationalOv
erviewReport_MARCH08.pdf (accessed 16 March 2011)
49.
General Medical Services contract for UK general practices, introduced in
2004, Quality and Outcomes Framework (QOF). The 2009/10 revision of
the QOF
http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesC
ontract/QOF/Pages/QualityOutcomesFramework.aspx (accessed 16 March
2011)
50. National Resource Centre for Ethnic Minority Health . Final Report.
Achievements and challenges in ethnicity and health in NHS Scotland.
2009 http://www.healthscotland.com/uploads/documents/11260NRCEMH_FinalReport.pdf (accessed 16 March 2011)
51.
National Resource Centre for Ethnic Minority Health. Diabetes in
Minority Ethnic Groups in Scotland. 2004
http://www.healthscotland.com/documents/2472.aspx (accessed 16 March
2011)
52.
Pankaj V. Current Status of Cultural Competency Training in NHS
Scotland. National Resource Centre for Ethnic Minority Health. 2004 (Please
contact [email protected] to see this resource.)
53.
National Resource Centre for Ethnic Minority Health. Peer Review
Toolkit. 2004. (Please contact [email protected] to see this
resource.)
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 66 of 90
Date: 26/01/11
Review Date: 27/01/11
54.
National Resource Centre for Ethnic Minority Health. Ethnic Monitoring
Toolkit. 2005 http://www.healthscotland.com/documents/2476.aspx
(accessed 16 March 2011)
55. National Resource Centre for Ethnic Minority Health. Now we're talking:
Interpreting guidelines for staff of NHS Scotland. 2008
http://www.healthscotland.com/documents/2790.aspx (accessed 16 March
2011)
56. Diabetes UK Update. Cultural Evolution. 2003
57. Baradaran HR, Knill-Jones RP, Wallia S et al. A controlled trial of the
effectiveness of a diabetes education programme in a multi-ethnic
community in Glasgow. BMC Public Health 2006; 6: 134
58. Hawthorne K, Robles Y, Cannings-John R et al. (2008). Culturally
appropriatehealth education for Type 2 diabetes mellitus in ethnic minority
groups.Cochrane Database of Systematic Reviews; 3: CD006424
59. Hawthorne K. Effect of culturally appropriate health education on
glycaemic control and knowledge of diabetes in British Pakistani women
withType 2 Diabetes Mellitus. Health Education Research 2001; 16(3):
373–381
60. Baradaran H. A controlled trial of the effectiveness of a diabetes education
programme in a multi-ethnic community. In: Diabetes in Minority Ethnic
Groups in Scotland. A report by the National Resource Centre for Ethnic
Minority Health in collaboration with the Scottish Diabetes Group. NHS
Health Scotland 2004, p132-134.
61. Khunti K, Camosso-Stefinovic J, Carey M et al. Educational interventions
for migrant South Asians with Type 2 diabetes: a systematic review.
Diabetic Medicine 2008; 25: 985–992
62. Liverpool Health Authority. Black and Minority Ethnic Health Service
Provision in Liverpool Primary Care Trusts. 2001. Pages 14-16.
63. Hall, L. Black and Minority Ethnic Health Improvement Services – Health
Development Service: Service Report 2005-06. Newcastle Primary Care
Trust. 2006.
64. Hawthorne K, Tomlinson S. One-to-one teaching with pictures –flashcard
health education for British Asians with diabetes. The British Journal of
General Practice 1997; 47: 301–304
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 67 of 90
Date: 26/01/11
Review Date: 27/01/11
65. Greenhalgh T, Collard A and Begum N. Sharing stories: complex
intervention for diabetes education in minority ethnic groups who do not
speak English. BMJ 2005; 330: 628-633.
66. O‟Hare JP, Raymond NT, Mughal S et al. Evaluation of delivery of
enhanced diabetes care to patients of South Asian ethnicity: the United
Kingdom Asian Diabetes Study (UKADS). Diabetic Medicine 2004; 21:
1357–1365
67. Lawton J, Ahmad N, Hanna L et al. Diabetes service provision: a
qualitative study of the experiences and views of Pakistani and Indian
patients with Type 2 diabetes. Diabetic Medicine 2006; 23: 1003–1007
68. Stone MA, Patel N, Daly H et al. Using qualitative research methods to
inform the development of a modified version of a patient education
module for non-English speakers with Type 2 diabetes: experience from
an action research project in two South Asian populations in the UK.
Diversity in Health and Social Care 2008; 5(3): 199–206
69. Vyas A, Haidery AZ, Wiles PG et al. A pilot randomized trial in primary
care to investigate and improve knowledge, awareness and selfmanagement among South Asians with diabetes in Manchester. Diabetic
Medicine 2003; 20:1022–1026
70. Kerr L, Wilson D, Murray S et al. Crossing the language and cultural
barriers of diabetes. Poster presentation, cited in Sommerfield T. BME
diabetes services in Lothian: a healthcare needs assessment. NHS
Lothian 2006.
71. Rhodes P and Nocon A. A problem of communication? Diabetes care
among Bangladeshi people in Bradford. Health and Social Care in the
Community 2003; 11: 45–54
72. Stone M, Pound E, Pancholi A et al. Empowering patients with diabetes:
qualitative primary care study focusing on south Asians in Leicester, UK.
Family Practice 2005; 22: 647–652
73. Hawthorne K. Accessibility and use of health care services in British Asian
community. Family Practice 1994; 11: 453–459
74. Griffiths C, Motlib J, Azad A et al. Randomised controlled trial of a layled
self-management programme for Bangladeshi patients with chronic
disease. British Journal of General Practice 2005; 55: 831–837
75. Choudhury SM, Brophy S, Fareedi MA et al. Intervention, recruitment and
evaluation challenges in the Bangladeshi community: Experience from a
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 68 of 90
Date: 26/01/11
Review Date: 27/01/11
peer led educational course. BMC Medical Research Methodology 2008;
8: 64
76. Fagerli RA, Lien ME, Wandel M. Experience of dietary advice among
Pakistani-born persons with Type 2 diabetes in Oslo. Appetite 2005; 45:
295–304
77. Lawton J, Ahmad N, Hanna L et al. ‘I can’t do any serious exercise’:
barriers to physical activity amongst people of Pakistani and Indian origin
withType 2 diabetes. Health Education Research 2006; 21(1): 43–54
78. Sriskantharajah J and Kai J. Promoting physical activity among South
Asian women with coronary heart disease and diabetes: what might help?
Family Practice 2007; 24(1): 71–76
79. Diabetes UK. Diabetes care and you, What diabetes care you can expect
2009 https://www.diabetes.org.uk/OnlineShop/New-to-Diabetes/Whatdiabetes-care-to-expect/ (accessed 15 March 2011)
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 69 of 90
Date: 26/01/11
Review Date: 27/01/11
Appendices
Appendix 1
Focus Groups with Pakistani and Chinese Patients with Diabetes
Semi-structured interview schedule
What you should expect from the NHS
Access to healthcare
1. Do you feel your race, religion or belief has affected your access to services?
Quality of care
2. What do you feel about the quality of care you receive?
Information and choice
3. Have you been given any information about your treatment (risks, benefits,
alternative treatments etc)?
4. Are you aware that you have a choice to accept or refuse treatment?
5. What do you think about privacy and confidentiality in the NHS?
6. Have you ever asked to see your health records and/or received copies of letters
about your care?
7. Have you made any choices about your NHS care?
8. Have you been informed about the health services available to you?
Working together with your healthcare team
9. Have you been involved in discussions and decisions about your healthcare, and
be given information to help you with this?
10. Have you had a say in the planning of healthcare services to the NHS?
Complaints
11. Have you ever made any complaint about NHS services?
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 70 of 90
Date: 26/01/11
Review Date: 27/01/11
Working together with your diabetes healthcare team
12. Where is your diabetes care provided?
13. Have you been referred to see any specialists in a health centre or hospital?
14. Do you know the roles and responsibilities of those providing your diabetes care?
15. Planning your care with your diabetes healthcare team; are you actively involved
in deciding how your diabetes will be managed?
16. During your appointments, do you discuss your concerns and questions with
members of your healthcare team?
Topics participants would like more information about include:
17. Would you find getting a paper copy of your care plan from your diabetes
healthcare team useful in helping you manage your diabetes?
18. Do you have a full review at least once a year and at ongoing intervals
What care you should expect from your healthcare team
19. When you were first diagnosed with diabetes, did you have a medical examination
and discussion with a member of your diabetes healthcare team?
20. When you were first diagnosed with diabetes, did you receive an explanation of
what is on offer for you to learn more about diabetes and keeping well?
21. When you were first diagnosed with diabetes, did you see a registered dietitian?
22. Once you received initial information and treatment, what did your ongoing care
include?
23. As part of your ongoing care, what support did you receive from your diabetes
healthcare team to help you to manage your diabetes?
24. As part of your ongoing care, what support would you have liked to receive from
your diabetes healthcare team to help you to manage your diabetes?
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 71 of 90
Date: 26/01/11
Review Date: 27/01/11
Your role in self-managing your diabetes
25. Do you recognize your role in your health and take some personal responsibility
for managing it day-to-day?
26. Do you give accurate information about your health and how you are feeling?
27. Do you put into everyday practice the goals you may have agreed in your care
plan about healthy eating, physical activity, taking your medication and
monitoring your blood glucose levels?
28. Do you examine your feet regularly between reviews?
29. Do you know how to manage your diabetes and when to ask for help if you are ill,
for example if you have diarrhoea and are vomiting?
30. Do you know when, where and how to contact your diabetes healthcare team?
31. Do you attend your appointments or rearrange them as soon as possible?
32. Do you make a list of points to raise at your appointments?
33. Do you carry some form of medical identification about your diabetes?
34. Do you discuss with your diabetes healthcare team if you are pregnant or planning
to become pregnant?
35. Do you give feedback to your healthcare team about the treatment and care you
have received?
36. Do you treat NHS staff with respect?
37. What support do you think you may need from other people?
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 72 of 90
Date: 26/01/11
Review Date: 27/01/11
Appendix 2
Focus Group with Interpreters
Section 1: Demographic Details
1.0 Number of interpreters:
Language(s) interpreted:
1.1 In which Community Health Partnership (CHP) and /or operational division do you work?
Section 2: Your Workload
2.0 In your current workload, do you interpret for any BME patients with patients from the
following communities?
South Asian, Black African / Caribbean, Chinese, Asylum seekers and refugees, Migrant
workers e.g. Polish and/or Gypsy/Travelers
2.1 If you responded “yes” to the last question, how would you describe the amount of time that
you spend with any BME patients with diabetes from the following communities?
South Asian, Black African / Caribbean, Chinese, Asylum seekers and refugees, Migrant
workers e.g. Polish and/or Gypsy/Travelers
2.2 If you answered “too much” to the last question, please can you provide further details of
why you spend more time with BME patients with diabetes:
Section 3: Ethnic Data Recording
3.0 In your current practice, do you routinely record any of the following data about your BME
patients with diabetes?
Ethnicity, Language spoken, Language read, Religion, Diet e.g. vegetarian, halal etc,
Preferred gender of healthcare professional patient would like to be seen by, Use of herbal
and traditional remedies e.g. karela, ayurvedic, Chinese etc Other (specify):
3.1 If you answered “yes” to the last question, where do you routinely record any of the
following data about your BME patients with diabetes?
Electronically
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
On paper
Version: 1
Page 73 of 90
Date: 26/01/11
Review Date: 27/01/11
Section 4: Specialist Resources
4.1 Are you aware of any Diabetes UK resources available in different languages for BME
patients with diabetes?
4.2 Have you ever used any Diabetes UK resources with your BME patients with diabetes?
4.3 Are there any additional resources that you require for BME patients with diabetes from the
following communities?
Resources Topics
Patient Groups
South
Asian
Black
African /
Caribbean
Chinese
Asylum
seekers and
refugees
Migrant
workers
(Polish)
Gypsy/
Travelers
Diabetes prevention
Type 1 Diabetes
Type 2 Diabetes
Healthy lifestyle
Fasting
Herbal remedies
Travel
Short term
complications
Long-term
complications
Pre pregnancy /
Pregnancy
Insulin and
medications
Other topics
Please specify:
4.4 If you felt additional resources were required, please can you provide further details (inc. the
language) of the resources that you might find helpful:
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 74 of 90
Date: 26/01/11
Review Date: 27/01/11
Section 5: Problems Encountered
5.0 In your practice, have you ever encountered any problems when working with BME patients
with diabetes from the following communities?
South Asian, Black African / Caribbean, Chinese, Asylum seekers and refugees, Migrant
workers e.g. Polish and/or Gypsy/Travelers
5.1 If you answered “yes” to the last question, have you ever encountered any of the following
problems when working with BME patients with diabetes?
Communication difficulties, Cultural and religion issues, Dietary issues, Lifestyle issues,
Poor adherence to prescribed medication, Poor self management skills, Other Please specify:
5.2 If you answered “yes” to the last question, please can you provide further details of the
problems that you encountered (without identifying any specific patient):
Section 6: Culturally Competent Services
6.0 Diabetes UK has produced a checklist to enable healthcare providers to assess the cultural
competence of their diabetes services.
In this question we would like to find out what factors, if any you might consider when
providing services to BME patients with diabetes.
Cultural sensitivities, Patient’s reading ability (In English or own language), Need for
education, Need for information resources, Dietary issues, Lifestyle issues, Awareness of
patient’s local sources of information or support, Awareness of patient’s of Diabetes UK’s
free language materials and Careline interpreting services, Other Please specify:
Section 7: Professional Education and Training
7.0 Have you ever received any training about delivering culturally competent services for BME
patients with diabetes from the following communities?
South Asian, Black African / Caribbean, Chinese, Asylum seekers and refugees, Migrant
workers e.g. Polish and/or Gypsy/Travelers
7.1 If you answered “yes” to the last question, did the training help you to provide culturally
competent services for BME patients with diabetes?
7.2 Do you think you would benefit from any training to help you provide culturally competent
services for BME patients with diabetes from the following groups?
South Asian, Black African / Caribbean, Chinese, Asylum seekers and refugees,
Migrant workers e.g. Polish and/or Gypsy/Travelers
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 75 of 90
Date: 26/01/11
Review Date: 27/01/11
7.3 The NHS is committed to developing a culturally competent workforce to deliver services.
In this question we would like to find out what training, if any you might require to deliver
culturally competent services for BME patients with diabetes?
Cultural and religious diversity, Communication skills, BME diabetes patient education
programmes, BME diabetes specialist information resources, Dietary issues, Lifestyle issues,
Ethnic specific values for body mass index and waist circumference,
Awareness of patient’s local sources of information and support, Other please specify:
7.4 If you answered “yes” to the last question, please can you provide further details about the
training you might benefit from:
Thank you for participating in this focus group session.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 76 of 90
Date: 26/01/11
Review Date: 27/01/11
Appendix 3
Questionnaire
Health Needs Assessment of Black and Minority Ethnic Patients with Diabetes in NHS Fife
Introduction
Fife has seen a steady increase in the incidence of diabetes which poses serious clinical and
economic challenges for the NHS. The number of people in Fife with diabetes in 2009 was
16,759 which represented 4.6% of the total population.
Research has identified people from black and minority ethnic (BME) groups are at an increased
risk of developing diabetes. For example, South Asians are six times more likely to develop type
2 diabetes than someone from the white population.
The estimated number of BME people in Fife with diabetes in 2010 was 664, which represented
4.4% of the total diabetic population. Of these, the largest distinct groups represented were
Pakistani, Indian, black African Caribbean, other South Asian, any mixed background and
Chinese. However, this is likely to be an underestimate of the true BME population as refugees
and asylum seekers, recent migrant workers and gypsy/travelers were not included.
The Scottish Government is committed to ensure that all people with diabetes have access to the
best quality care and treatment. Policy documents recommend the provision of services and
initiatives which are inclusive and are delivered through culturally sensitive means. In order to
facilitate the planning for such services in NHS Fife a modified health needs assessment project
has been undertaken.
As part of the project this questionnaire has been developed to obtain views from healthcare
professionals (HCPs) about the services they provide for BME patients with diabetes in NHS Fife
The objectives of the questionnaire are:






To establish the impact of BME patients on HCPs workloads
To identify what relevant ethnic data is routinely recorded by HCPs
To identify what specialist resources are available, used and required by HCPs
To identify problems encountered by HCPs working with BME patients
To find out what factors HPCs consider when providing culturally competent services
To find out what training HCPs require to deliver culturally competent services
Your response to this short questionnaire which will take you approximately 10 minutes to
complete will be extremely valuable to help NHS Fife plan services and educational programmes
to improve service provision for BME patients with diabetes.
Survey monkey instructions
Survey monkey link
If you have any queries please do not hesitate to contact me by e-mail [email protected]
or telephone 01592 226849.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 77 of 90
Date: 26/01/11
Review Date: 27/01/11
On behalf of the Diabetes MCN I would like to thank you for your time and commitment in
assisting us to ensure that patient centred care is part of our core business for patients with
diabetes in NHS Fife.
Yours sincerely,
Chanda Bhogaita
Ethnic Minority Project Officer
Diabetes MCN
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 78 of 90
Date: 26/01/11
Review Date: 27/01/11
Section 1: Demographic Details
4.0 What is your occupation?
Please tick √ one answer
Consultant physician/diabetologist
General practitioner (GP)
Diabetes specialist nurse
Practice nurse
Diabetes specialist dietitian
Optometrist/ophthalmologist
Diabetes specialist podiatrist
Psychologist
Pharmacist
Other healthcare professional
Please specify:
□
□
□
□
□
□
□
□
□
□
4.1 In which Community Health Partnership (CHP) and /or operational division do you work?
Please tick √ all answers that apply
Dunfermline and West Fife CHP
Glenrothes and North East Fife CHP
Kirkcaldy and Levenmouth CHP
Victoria Hospital
Queen Margaret Hospital
Forth Park Hospital
Other
Please specify:
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 79 of 90
□
□
□
□
□
□
□
Date: 26/01/11
Review Date: 27/01/11
Section 2: Your Workload
5.0 In your current workload, do you manage any BME patients with patients from the following
communities?
Please tick √ all answers that apply
South Asian
Black African / Caribbean
Chinese
Asylum seekers and refugees
Migrant workers e.g. Polish
Gypsy/Travelers
Yes
No
□
□
□
□
□
□
□
□
□
□
□
□
5.1 If you ticked any “yes” boxes in question 2.0, please describe the amount of time that you
spend with any BME patients with diabetes from the following communities.
Please tick √ all answers that apply
South Asian
Black African / Caribbean
Chinese
Asylum seekers and refugees
Migrant workers e.g. Polish
Gypsy/Travelers
Too
Little
Enough
Too
much
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
5.2 If you ticked any “too much” boxes in question 2.1, please can you provide further details of
why you spend more time with BME patients with diabetes:
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 80 of 90
Date: 26/01/11
Review Date: 27/01/11
Section 3: Ethnic Data Recording
6.0 In your current practice, do you routinely record any of the following data about your BME
patients with diabetes?
Please tick √ all answers that apply
ethnicity
Language spoken
Language read
Religion
Diet e.g. vegetarian, halal etc.
Preferred gender of healthcare professional
Patient would like to be seen by
Use of herbal and traditional remedies
e.g. karela, ayurvedic, Chinese etc
Yes
No
□
□
□
□
□
□
□
□
□
□
□
□
□
□
6.1 If you ticked any “yes” boxes in question 3.0, where do you routinely record any of the
following data about your BME patients with diabetes?
Please tick √ all answers that apply
Electronically On paper
Ethnicity
Language spoken
Language read
Religion
Diet e.g. vegetarian, halal etc.
Preferred gender of healthcare professional
patient would like to be seen by
Use of herbal and traditional remedies
e.g. karela, ayurvedic, Chinese etc
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 81 of 90
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Date: 26/01/11
Review Date: 27/01/11
Section 4: Specialist Resources
4.5 Are you aware of the following Diabetes UK resources available in different languages for
BME patients with diabetes?
Please tick √ all answers that apply
Yes
No
□
□
□
□
□
□
DVD raising awareness about diabetes:
Meethi Baatein/Sweet Talk (Available in English and Hindi)
Booklets about healthy living with diabetes:
Living healthily with diabetes - a guide for Black African-Caribbean
communities (Available in English)
Healthy eating for the South Asian Community (Available in English,
Bengali, Gujarati, Hindi, Punjabi and Urdu)
Information sheets about living with diabetes:
(Available in English, Bengali, Gujarati, Hindi, Punjabi, Urdu, Chinese, Somali, and Arabic)
What is diabetes?
Managing diabetes
Healthy lifestyle, fasting and diabetes
Ramadan and diabetes (Not available in Chinese, Somali, and Arabic)
Hypoglycaemia
Diabetic complications
How Diabetes UK can help you
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Information sheets about coping with diabetes:
(Available in English, Bengali, Gujarati, Hindi, Punjabi, Urdu, and Chinese)
Treating your diabetes: insulin and tablets
Cardiovascular disease and kidney disease
Your eyes and diabetes
Nerve damage and diabetes
Pregnancy and diabetes
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 82 of 90
□
□
□
□
□
Date: 26/01/11
Review Date: 27/01/11
□
□
□
□
□
4.6 Have you ever used any of the following Diabetes UK resources with your BME patients
with diabetes?
Please tick √ all answers that apply
Yes
No
□
□
□
□
□
□
DVD raising awareness about diabetes:
Meethi Baatein/Sweet Talk (Available in English and Hindi)
Booklets about healthy living with diabetes:
Living healthily with diabetes - a guide for Black African-Caribbean
communities (Available in English)
Healthy eating for the South Asian Community (Available in English,
Bengali, Gujarati, Hindi, Punjabi and Urdu)
Information sheets about living with diabetes:
(Available in English, Bengali, Gujarati, Hindi, Punjabi, Urdu, Chinese, Somali, and Arabic)
What is diabetes?
Managing diabetes
Healthy lifestyle, fasting and diabetes
Ramadan and diabetes (Not available in Chinese, Somali, and Arabic)
Hypoglycaemia
Diabetic complications
How Diabetes UK can help you
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Information sheets about coping with diabetes:
(Available in English, Bengali, Gujarati, Hindi, Punjabi, Urdu, and Chinese)
Treating your diabetes: insulin and tablets
Cardiovascular disease and kidney disease
Your eyes and diabetes
Nerve damage and diabetes
Pregnancy and diabetes
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 83 of 90
□
□
□
□
□
Date: 26/01/11
Review Date: 27/01/11
□
□
□
□
□
4.7 Are there any additional resources that you require for BME patients with diabetes from the
following communities?
Please tick √ all answers that apply
Resources Topics
Patient Groups
South
Asian
Black
African /
Caribbean
Chinese
Asylum
seekers and
refugees
Migrant
workers
(Polish)
Gypsy/
Travelers
Diabetes prevention
Type 1 Diabetes
Type 2 Diabetes
Healthy lifestyle
Fasting
Herbal remedies
Travel
Short term
complications
Long-term
complications
Pre pregnancy /
Pregnancy
Insulin and
medications
Other topics
Please specify:
4.8 If you ticked any boxes in questions 4.3, please can you provide further details (inc. the
language) of the resources that you might find helpful:
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 84 of 90
Date: 26/01/11
Review Date: 27/01/11
Section 5: Problems Encountered
8.0 In your practice, have you ever encountered any problems when working with BME patients
with diabetes from the following communities?
Please tick √ all answers that apply
South Asian
Black African / Caribbean
Chinese
Asylum seekers and refugees
Migrant workers e.g. Polish
Gypsy/Travelers
Yes
No
□
□
□
□
□
□
□
□
□
□
□
□
8.1 If you ticked any “yes” boxes in question 5.0, have you ever encountered any of the following
problems when working with BME patients with diabetes?
Please tick √ all answers that apply
Communication difficulties
Cultural and religion issues
Dietary issues
Lifestyle issues
Poor adherence to prescribed medication
Poor self management skills
Other
Please specify:
Yes
No
□
□
□
□
□
□
□
□
□
□
□
□
□
□
8.2 If you ticked any “yes” boxes in question 5.1, please can you provide further details of the
problems that you encountered (without identifying any specific patient):
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 85 of 90
Date: 26/01/11
Review Date: 27/01/11
Section 6: Culturally Competent Services
9.0 Diabetes UK has produced a checklist to enable healthcare providers to assess the cultural
competence of their diabetes services.
In this question we would like to find out what factors, if any you might consider when
providing services to BME patients with diabetes.
Please tick √ all answers that apply
Cultural sensitivities
Need for an interpreter
Patient’s reading ability
(In English or own language)
Need for education
Need for information resources
Dietary issues
Lifestyle issues
Awareness of patient’s local sources of
information or support
Awareness of patient’s of Diabetes UK’s
free language materials and
Careline interpreting service
Other
Please specify:
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 86 of 90
□
□
□
□
□
□
□
□
□
□
□
Date: 26/01/11
Review Date: 27/01/11
Section 7: Professional Education and Training
10.0
Have you ever received any training about delivering culturally competent services for
BME patients with diabetes from the following communities?
Please tick √ all answers that apply
South Asian
Black African / Caribbean
Chinese
Asylum seekers and refugees
Migrant workers e.g. Polish
Gypsy/Travelers
Yes
No
□
□
□
□
□
□
□
□
□
□
□
□
10.1
If you ticked any “yes boxes” in question 7.0, did the training help you to provide
culturally competent services for BME patients with diabetes?
Please complete the following table:
Please tick √ one answer
Yes
No
Training Activity
Please provide details of the training you received e.g. course
title, provider, venue, and cost
□
□
□
□
□
□
□
□
□
□
10.2
Do you think you would benefit from any training to help you provide culturally
competent services for BME patients with diabetes from the following groups?
Please tick √ all answers that apply
Yes
No
South Asian
□
□
Black African / Caribbean
□
□
Chinese
□
□
Asylum seekers and refugees □
□
Migrant workers e.g. Polish
□
□
Gypsy/Travelers
□
□
10.3
The NHS is committed to developing a culturally competent workforce to deliver
services.
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 87 of 90
Date: 26/01/11
Review Date: 27/01/11
In this question we would like to find out what training, if any you might require to deliver
culturally competent services for BME patients with diabetes?
Please tick √ all answers that apply
Cultural and religious diversity
Communication skills e.g. using interpreter’s
BME diabetes patient education programmes
BME diabetes specialist information resources
Dietary issues
Lifestyle issues
Ethnic specific values for body mass index
and waist circumference
Awareness of patient’s local sources of
information and support
Other
Please specify:
□
□
□
□
□
□
□
□
□
10.4
If you ticked any “yes” boxes in question 7.3, please can you provide further details about
the training you might benefit from:
Survey monkey standard response to thank participant for completing the questionnaire
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 88 of 90
Date: 26/01/11
Review Date: 27/01/11
Appendix 4:
Ethnic minorities: ethnic classification in the Census
The table below shows approximate relationships between different Census classifications used in the UK.
1991 Great
Britain
Equivalent
White
Black-Other
Other-Other
Indian
Pakistani
Bangladeshi
Other-Asian
Caribbean
African
Other
Chinese
Other-Other
England and
Wales 2001
White: British
White: Irish
White: Other
White
Mixed: White
and Black
Caribbean
Mixed: White
and Black
African
Mixed: White
and Asian
Mixed: Other
Mixed
Asian or Asian
British: Indian
Scotland
2001
Northern
Ireland 2001
White Scottish White
Other White
British
White Irish
Other White Irish Traveller
Any Mixed
Background
Asian, Asian
Scottish or
Asian British:
Indian
Asian or Asian
Asian, Asian
British: Pakistani Scottish or
Asian British:
Pakistani
Asian or Asian
Asian, Asian
British:
Scottish or
Bangladeshi
Asian British:
Bangladeshi
Asian or Asian
Asian, Asian
British: Other
Scottish or
Asian
Asian British:
Any other
Asian
background
Black or Black
Black, Black
British:
Scottish or
Caribbean
Black British:
Caribbean
Black or Black
Black, Black
British: African
Scottish or
Black British:
African
Black or Black
Black, Black
British:Other
Scottish or
Black
Black British:
Other Black
Chinese or other Asian, Asian
ethnic group
Scottish or
:Chinese
Asian British:
Chinese
Chinese or other Other ethnic
ethnic group:
Background
Other Ethnic
Group
Mixed
Scotland 2011
White: Scottish
White: English, White: Welsh, White:
Northern Irish, White: British
White: Irish
White: Gypsy Traveller, White: Polish,
White: Other
Mixed or multiple
Indian
Asian: Indian, Indian Scottish or Indian
British
Pakistani
Asian: Pakistani, Pakistani Scottish or
Pakistani British
Bangladeshi
Asian: Bangladeshi, Bangladeshi
Scottish or Bangladeshi British
Other Asian
Asian, Asian Scottish or Asian British:
Other
Black
Caribbean
Caribbean, Caribbean Scottish or
Caribbean British
Black African
African, African Scottish or African
British
Other Black
African, Caribbean or Black: Other
Black, Black Scottish or Black British
Chinese
Asian: Chinese, Chinese Scottish or
Chinese British
Other ethnic
group
Other: Arab
Other
http://www.scotpho.org.uk/home/Populationgroups/Ethnicminorities/ethnic_data/e
thnic_classification.asp
Fife Diabetes MCN HNA
Author: Chanda Bhogaita
Version: 1
Page 89 of 90
Date: 26/01/11
Review Date: 27/01/11
90