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Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe

Diabetic medicine, 2021-11, Vol.38 (11), p.e14584 [Peer Reviewed Journal]

2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK. ;info:eu-repo/semantics/openAccess ;ISSN: 0742-3071 ;EISSN: 1464-5491 ;DOI: 10.1111/dme.14584 ;PMID: 33838051

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  • Title:
    Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe
  • Author: Davidson, Emma M ; Krasuska, Marta ; Jenum, Anne Karen ; Gill, Jason M R ; Beune, Erik ; Stronks, Karien ; van Valkengoed, Irene G M ; Diaz, Esperanza ; Sheikh, Aziz
  • Subjects: Adaptation, Psychological ; Asians ; Diabetes Mellitus, Type 2 - ethnology ; Diabetes Mellitus, Type 2 - prevention & control ; Europe - epidemiology ; Humans ; Life Style ; Morbidity - trends ; Population Surveillance
  • Is Part Of: Diabetic medicine, 2021-11, Vol.38 (11), p.e14584
  • Description: Selected lifestyle interventions proven effective for White-European populations have been culturally adapted for South Asian populations living in Europe, who are at higher risk of type 2 diabetes. However, a limited theoretical basis underpins how cultural adaptations are believed to augment intervention effectiveness. We undertook a realist review to synthesise existing literature on culturally adapted type 2 diabetes prevention interventions, to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'. We followed the stepped methodological approach of realist review. Our work concluded a European-wide project (EuroDHYAN), and core studies were identified from the preceding EuroDHYAN reviews. Data were extracted, coded into themes and synthesised to create 'Context-Mechanism-Outcome' configurations and to generate a refined explanatory framework. We identified eight core intervention papers. From this evidence, and supporting literature, we examined the 'Team' domain of cultural adaptation and identified a mechanism of shared cultural identity which we theorised as contributing to strong team-participant relationships. We also identified four key contexts which influenced intervention outcomes: 'research setting' and 'heterogeneous populations' (intrinsic to the intervention) and 'broader environment' and 'socio-cultural stress' (extrinsic barriers). This work instigates research into the mechanisms of cultural adaptation which, if pursued, will allow a more nuanced understanding of how to apply adaptations, and for whom. In practice we recommend greater consideration of heterogeneous and intersecting population characteristics; how intervention design can safeguard sustainability; and how the four key contexts identified influence how, and whether, these interventions work.
  • Publisher: England
  • Language: English;Norwegian
  • Identifier: ISSN: 0742-3071
    EISSN: 1464-5491
    DOI: 10.1111/dme.14584
    PMID: 33838051
  • Source: NORA Norwegian Open Research Archives
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