Black and minority ethnic (BME) groups - key issues

Potential barriers to providing effective care

Cultural and communication difficulties make it difficult for people from black and minority ethnic (BME) groups to access health care. The Testing Times report (Audit Commission 2000) revealed:

patient education was inadequate at half of the hospitals visited in the UK
minority ethnic patients were twice as likely to report gaps in their understanding of care.

Some years on from this, initiatives to target hard to reach groups are helping to support a more empowered and involved diabetes community (Department of Health 2007a). Nevertheless increasing numbers of people with diabetes and the greater emphasis on self care make it even more important to get the cultural aspects of patient education and support right.

An article published in the BMJ discusses management of people with diabetes wanting to fast during Ramadan and describes four key areas in Ramadan focused education (Hui E et al 2010).

In Britain, the term "Asian" suggests a single cohesive group but in reality the communities are from different countries, languages, religions, social class and traditions. Diversity in language, religion, cultural norms and expectations can prevent effective communication and create misunderstanding between the majority and minority groups.

Because of potential misunderstandings about the nature of their condition, there is an increased risk of individuals decreasing their medication when their diabetes is controlled, or stopping their medication when abroad (returning to their "homeland") believing their condition to be cured.

Culture is a complex concept and a multifaceted social phenomenon that has powerful influences on all aspects of life. Asian health beliefs often differ from Western health beliefs, which can result in misinterpretation of information about diabetes which may even be misconstrued as non-compliance to treatment. For example, Asian patients may have a dilemma with taking a lot of tablets and be concerned about the effects of these.

Strategies to overcome these barriers include:

Employing health care professionals, link workers and interpreters/ advocates from minority ethnic groups.
Ensuring that information is understood by having health care professionals check a patient’s understanding of what has been said to them, and ensuring that information has been translated appropriately in a culturally sensitive way.
Educating health care professionals on the health beliefs of different cultural communities - for example the giving and receiving of food at times of celebration has great cultural significance for many Asian families.
Enhancing family involvement – for example an individual may be reluctant to take personal responsibility for their condition, such as insulin adjustment and the preparation of food, and it is common within the Asian community for patients to give ownership of their diabetes to their family.

Health Scotland published a guide in 2007 which provides advice on organising diabetes awareness-raising events and setting up culturally sensitive services. The guide is made available on the Diabetes UK website – see A guide to working with black and minority ethnic communities in Scotland living with long-term conditions.

References

Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the Reference list.

For more information, go to: black and minority ethnic (BME) groups.