Misalignment: understanding the challenge of engaging with self-management advice for people living with diabetes in UK Black African and Caribbean communities

Abstract

Objectives: The incidence of type 2 diabetes in UK Black African and Caribbean communities is up to three times higher than in the general population, and engagement with self-management advice is poorer. This study explores the perspective of those living with diabetes to understand how the cultural salience of advice could be improved. Design: Participants were recruited via community venues, faith institutions and primary care. Eight focus groups were conducted with 41 individuals (Black African n = 23, Black Caribbean n = 18). Grounded theory methods were used for analysis. Results: Although motivated to manage the condition, individuals experienced a misalignment between elements of the care provision and cultural norms. Explanatory models of diabetes differed from the biomedical model reducing trust in treatment protocols. A lack of cultural salience reduced the accessibility of advice. Furthermore, elements of self-management advice were seen to conflict directly with some cultural traditions and practices. Individuals had to reconcile the two perspectives in order to proceed with self-management, often prioritising cultural norms and advice from informal sources over healthcare advice. Building personal relationships with the healthcare team improved trust and engagement. Conclusion: Findings suggest the needs in these communities were not being fully met. The healthcare interaction was pivotal in improving trust and engagement and reducing misinformation. However, appropriately informed community support also offers the potential to mitigate misalignment and to improve equity of access.