Scottish survey of diabetes services for minority ethnic groups
© Baradaran et al; licensee BioMed Central Ltd. 2006
Received: 24 January 2006
Accepted: 09 October 2006
Published: 09 October 2006
In the UK, all ethnic minority groups have higher rates of diabetes than the general population. Although there have been a number of projects to assess diabetic care amongst minority ethnic groups in the United Kingdom, little is known about the extent to which the needs of ethnic minority groups are actually met by the National Health Service (NHS) Scotland. Therefore we conducted this study to understand of the current situation for diabetes care available to minority ethnic groups in Scotland.
We conducted this cross-sectional study in all health boards in Scotland. A questionnaire was designed based on expert comments. It was completed by Local Health Care Cooperatives (LHCC) managers, chairs, diabetes specialist nurses and public health practitioners.
57 of questionnaires were returned (response rate = 69.5%). Of these LHCCs, 71% responded that diabetes was part of their LHCC plan. However 69% answered that ethnic group was not recorded by community services and GPs, and 80% of LHCCs did not monitor trends of complications of diabetes by ethnic group.
Improvement is needed in quality, completeness, and availability of minority ethnic group data for diabetes at a national level, particularly if NHS Primary Care Organisations are to be responsible for providing diabetes care as laid out in the Scottish Diabetes Framework.
The demographics of health boards in Scotland
Pakistani and other South Asian
Argyll & Clyde
Ayrshire & Arran
Dumfries & Galloway
Because there was no specific tool to assess the current situation for diabetes care generally and in particular for ethnic minority groups in Scotland, a questionnaire needed to be designed. Therefore we gathered ideas and comments from experts in this field. The first version of the questionnaire was designed, then it was sent to three LHCCs where Managers, Chairs, Diabetes Specialist Nurses and Public Health Practitioners completed and made comments. One of the recommended additions was to have some questions about availability of Scottish Intercollegiate Guidelines Network for Diabetes (SIGN Guideline 55) in the final version of the questionnaire. The questionnaire as distributed consisted of twelve closed questions in addition an open question. A total of 82 questionnaires were posted out to all LHCC managers in Scotland in March 2003 with a covering letter requesting completion of the questionnaire and an addressed envelope for return. Two weeks later, this was followed up with a reminder letter.
The results of the Questionnaire (Responses by Percentage)
Not sure/No response (%)
In progress (%)
Can you describe your LHCC by Census 2001 Ethnic Categories
Do Community Services & GPs record ethnic group
Do you combine ethnic demographic data with other sources to plan services
Is Diabetes part of your LHCC plan
Does your LHCC collect SIGN 55 data
Is SIGN 55 data recorded on GP systems
Does the LHCC monitor trends of complications by ethnic group
Are LHCC staff trained in Diabetes related to BMEGs
Do all patients have access to interpreters
Are procedures in place to record cultural/religious requirements
Is there appropriate dietetic counselling
Are appropriate health information materials available
The findings of the present study indicate that recording of ethnic group has not been considered a priority by LHCCs despite the importance of ethnicity in determining prevalence and complications of diabetes.
Of the LHCCs 66% did not collect data based on the 2001 census Ethnic Categories. Without this basic information, it is difficult for LHCCs to even begin to identify their demographic profile in order to assess the health needs of their minority ethnic population, although a demographic profile is a basic requirement of providing culturally sensitive and competent services.
GPs records & SIGN-55
The high response of GP practices and community services indicating that they do not record ethnic group (69%) can, in part, be attributed to current information systems. However, there seems to be some inconsistencies in respondents' responses, as 58% state that SIGN-55 guidelines , which indicates ethnic group as one of the core data items, is recorded on GP systems, but appears not to be acted upon. It is no surprise, therefore, that 80% of respondents report their inability to combine ethnic demographic data with other data sources to plan services and monitor complication trends between ethnic groups. Having such information would seem to be an important starting point in the ability of NHS organisations to reach a position to target their finite resources more effectively. The absence of robust information is disconcerting, in that diabetes is reported to be specifically identified by 71% of LHCC plans. Only one LHCC supplied their LHCC plan, describing their demographic profile by ethnic group and their intention to target more effectively Minority Ethnic Groups by joint working with a neighbouring LHCC and involving leaders of local minority ethnic health group.
From the comments section, there is also evidence that altering attitudes of NHS organisations requires ongoing change management, education and training. In some LHCCs numbers appear to be small as some respondents concluded: "...As percentage very low (referring to Minority Ethnic Groups) there is no specific section within the LHCC plan. All patients are treated equally within the LHCC," and another: "Numbers are so small we do not have a specific programme for ethnic groups," and another: "As patient records are confidential don't know what SIGN-55 data is recorded."
The findings that only 55% of LHCCs have access to interpreters, 55% do not record cultural/religious requirements, 24% have no culturally appropriate dietetic counselling and 33% have no appropriate health information materials available suggests that much is still required in improving the patient journey for ethnic minorities within the NHS.
Training and development of NHS staff are needed to help bring about such radical service improvements, giving people at the frontline the opportunity to develop appropriate skills and resources to do a better job . This builds on Our National Health , which gave a commitment to: "...Ensure that NHS staff are professionally and culturally-equipped to meet the distinctive needs of people and family groups from minority ethnic communities". Therefore, it is concerning that 42% of respondents report that their LHCC staffs are not trained in diabetes in relation to Minority Ethnic Groups and 13% are unsure. Patients normally have their first contact with Primary Care staff, who manage 90% of patient contacts within the NHS.
Limitation of the study
Similar to all research, this study had limitation. Since there was lack of census data on the number of ethnic minorities in each LHCC, therefore we could not compare and analyse the differences between LHCCs.
This study indicates that cultural health care practices should be improved and staff attitudes changed by the delivery and uptake of effective and appropriate training, and as part of this effort community participation by minority ethnic groups should be encouraged to assist in identifying their specific needs for targeted health services and related information.
This project was supported by a grant from Health Scotland through a grant from the NRCEMH (National Resource Centre for Ethnic Minority Health).
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