People from South Asia are considered as the largest minority ethnic group in UK. This ethnic group includes people from India, Pakistan, Bangladesh and Sri Lanka. This group is called as largest ethnic group because the population of these people is second largest after the white Europeans. There are many factors that influence the health of these people. In the several urban locations of UK comprises of the large population of South Asians. Studies reveal that this population is at higher risk of diabetes and obesity in comparison to general population of UK. Mortality rate of South Asians due to coronary heart disease is 40% higher than remaining UK population.
Therefore it is important to identify the health belief of South Asian descents and explore various lifestyle related issue that influence the health of this minority community in UK. Therefore, Part A will provide the health assessment of the people from South Asian community in UK and will identify the major health issue in this community. This part will further discuss the current intervention and programs to target the major health issue, strength and weakness of the interventions or programs, and will also throw light on PEST framework to eliminate the barriers in achieving good health. According to the critical analysis the effectiveness of the current interventions and programs is evaluated in Part B. This section also developed a community based project to address the health care problem and improve health of South Asians in UK. The project will be evaluated on the basis of SWOT analysis.
Part A
Health Assessment of South Asian Population in UK
According to the 2011 UK Census, people from South Asian community are the second largest ethnic community of the UK. Approximately 4.9% of the total population has identified themselves from the South Asian countries. Health behavior of the South Asian population is affected by various reasons, such as, socio economic status, family conflicts, diet, work patters, attitude/beliefs (Lucas, Murray, and Kinra, 2013, p. 3). Major issue in the ethnic or minority population is the lifestyle changes that influence the health behavior of people. Culture and ethnicity have the strong influence on the life of people. An ethnic belonging or a cultural status impacts the lifestyle of the population and explains the predisposition to chronic diseases. For any health interventions to be successful in the ‘at risk’ or target community, the healthcare providers and policy makers have to focus on lifestyle, belief and values of the target group. Health behavior will provide the details about the habits, health determinants, social factors and cultural norms.
Qualitative research in this area will be helpful in providing the strategy of the health promotion and encouraging healthy lifestyle. The studies show very little evidence of the successful intervention or programs for the health behavior of South Asian groups. There are very limited evidences related to cognitive determinants of health in south Asian population in comparison to general population. Ethnicity does not just display the language or cultural difference, but it also reflects the health beliefs of people, which significantly impacts the health behavior. However, health behavior studies in South Asian population are still very limited.
Studies have found that South Asian population in UK has the difficulty in identifying the various lifestyle related factors that contribute to many chronic diseases and health aspects related to obesity and diabetes (Lucas, Murray, and Kinra, 2013, p. 9). The studies have found that South Asian community also lacks the knowledge about the relationship between unhealthy lifestyle and various diseases such as sleep apnea and breathing problems (Amin et al, 2017, p. 38). Due to difficulty in relating to various lifestyle factors, obesity has grown as the major cause of diabetes. The studies found the people diagnosed with the lifestyle related disease were not convinced that their lifestyle choices have impacted their health and it becomes a great barrier to attain good health (Sohal et al, 2015p. 40). This explains the people also have poor literacy about health. The risk of disease has been attributed to heredity, stress, fired food, high sugar intake and also pollution. Therefore, it can be said that diet is another important factor of influencing the health of this community and increasing the prevalence of obesity and diabetes. Some of the common diseases found in the South Asian population are obesity, diabetes and cardiovascular disease. These people are not able to explain the root cause behind their disease and display genetic heteroginity (Sohani et al, 2014p. 3).
Very few people are aware of their attitude and lifestyle choice that influence their health. Wilkinson, Whitehead, and Ritchie, (2014)examined that the first generation population of South Asian origin are not able to self-manage diabetes and associate the development of the chronic disease with the factors, which are out of their control, and also this population consider it as the will of God, climatic factors, environment changes due to migration and also genetics (p. 112). Many of the participants in various studies informed about the lifestyle advice of their doctors or health professionals, but it was but able to transform their belief or health behavior. For example, it was found that males were aware of the serious effects of smoking tobacco. However, very few of them were convinced that it can negatively affect their health (Patel et al, 2015, p. 58).
Studies found lack of physical activities and physical fitness. Sedentary lifestyle and unhealthy diet has increased the problem. South Asians people are more likely to link their illness with the external environment and factors instead of the internal factors and health behavior. Also, the cultural influence is very high. South Asians believe that whatever happens in life is due to their fate. Therefore, for the serious illness like diabetes and obesity also, these people consider it as their fate. Fatalism is stimulated by the religious belief of the South Asian people. Many of the studies have found that this population associates their chronic illness with their fate. Older generation believe that external factors and agents outside the body are responsible for the illness rather than that their organ had failed to work properly (Patel et al, 2015, p. 59). Even the young generation of the South Asian community, who has the family history of diabetes and cardiovascular disease, mentioned the idea of God with their health status and individual behavior does not seem to be responsible. Diseases or illness could also be understood as the will of God or the indication of the God to inform the individual that they are not looking after their health. The idea of God being associated with health behavior was mainly displayed by the South Asian females (Lucas, Murray, and Kinra, 2013).
Weight gain is also considered as the normal ageing process and also inevitable. Women often display such feeling of resignation that nothing could be done about their growing weight and changing health. According to the studies, the health behavior of the South Asians increases the risk of coronary heart diseases (CHD), obesity and diabetes (Patel, Phillips-Caesar, and Boutin-Foster, 2012). People living with problem of diabetes and CHD also displayed depressive symptoms and anxiety due to the lack of health literacy and knowledge, to understand the actual reasons of their health problems (Rawlins, Baker, Maynard, and Harding, 2013). Feeling of hopelessness and anxiety is increased due to the lack of individual ability to control health.
Language barrier is also identified, as a significant barrier due to which older generation lack interest in understanding own condition through professional information. The image of doctor is very important in this community and people often require the family member to translate during visiting a doctor. This is the reason that people ask limited questions to the doctor, so that they may not seem to be difficult. History of diabetes among the family members and friends and other reference to the family networks are considered to be the most important information support. Younger South Asians display that they understand the importance of education for having a firm control over their health. However, young people do not attend educational classes or support group sessions, excusing for lack of time (Patel, Phillips-Caesar, and Boutin-Foster, 2012).
Major Health Issue
According to the 2011 UK census prevalence of diabetes is very high among the South Asian population. Of diabetes is 14% higher than general population of UK and there are no specific interventions to address this problem (Shrivastava and Misra, 2015, p. 435). Health assessment of the South Asian population in UK suggests that health behavior of this community is significantly affected by their cultural, religious and social belief. South Asian people in UK are developing obesity and diabetes on higher rate and also this community at the higher risk of developing type2 diabetes in comparison to European population. According to the study of Gujral et al, (2013), prevalence of type2 diabetes is very high among the South Asian community in their home countries as well as abroad. The biological changes with rapid changes in diet, physical activities and lifestyle have increased this prevalence. The problem is very high because of the lack of preventive measures at the early stage and this community is also culturally sensitive and strong in their religious beliefs (Wilkinson, Randhawa and Singh, 2014, p.29).
The major risk factors are the family history of diabetes and smoking tobacco. The major lifestyle factors contributing to the high prevalence of type 2 diabetes is the unhealthy diet, lack of nutrition and physical activities (Cross-Bardell et al, 2015). The future lifestyle intervention requires to mainly focusing on the prudent diet considering as the primary prevention strategy for preventing diabetes. South Asian population has a unbalanced diet which is high on carbohydrates, saturated fatty acids and calories, while they lack high protein diet and fiber. The dietary factors have been studied in the south Asian population in terms of cancers, and coronary heart disease, while there is a lack of studies explaining the dietary intake of South Asians in relation to diabetes (Mahmood, Afshar, and Tang, T.S. 2017, p. 27). According to the comprehensive literature it is found that major health issue in the South Asian population is type2 diabetes. Type 2 diabetes is a chronic illness. The can result in many other health problems. South Asian population suffers from type 2 diabetes because of various lifestyles, cultural and socio-economic factors. These factors collectively affect the health status of people.
Since South Asians are among the largest ethnic community in UK. It is also considered as the important target group for the screening and prevention program and Government works towards providing them optimal and individualized care. However, there is lack of appropriate and specific interventions to target South Asian community. The current intervention includes the guidelines published by NICE for preventing type 2 diabetes. These guidelines provide the details about the high risk populations and how the risk assessment should be carried out. Guidelines include the screening program for the South Asians aged between 25 and 39. Fasting plasma glucose (FPG) or HbA1c blood test is recommended for all the South Asians above the age of 25 (Ambady et al, 2013). If the blood test of the people indicates that they are at slight risk of developing diabetes, than it is recommended that they receive lifestyle appropriate advice and support of tailored services. Individual at the higher risk of developing diabetes are required to be provided with intensive lifestyle change interventions from health care professionals. NHS Diabetes Prevention Programme is the current intervention that is involved in screening and diagnosis of the type 2 diabetes in diverse population (NHS Diabetes Prevention Programme (NHS DPP), 2016).
Strength and Weaknesses of interventions
The strength of the diabetes prevention interventions and programs in UK is that they provide early screening and diagnosis facility for diabetes. The recommended blood test is very accurate screening strategy that can help in early detection. There is a lack of culturally appropriate care that becomes the major weakness of the diabetes prevention interventions and programs. There are also various barriers to the appropriate implementation of the programs such as, there is a lack of awareness among the South Asian population regarding obesity and type 2 diabetes. There is also a lack of culturally sensitive programs for diabetes prevention, due to which target population is not appropriately served. There is also lack of integration among the government, community, media, educational services and healthcare services (Ambady et al, 2013). The national and international diabetes prevention services and organization requires better financial support to provide comprehensive services to the target community. The lack of community oriented programs makes the programs insignificant.
PEST Analysis To Discuss Barriers
Political: The political factors deal with the regulations’, policies and laws associated with the government of the Country. The health care system of UK works on the government policies an regulations. South Asians often have to face health inequality due to migration regulations and government policies (Mako, 2013). Political reasons lead to uneven distribution of health resources. These barriers can be addressed by reforming or changing the policies and regulation related to immigrant status. So that people may access healthcare facilities easily.
Economic: Economic status of the South Asian population determines that status of their health. Due economic factors and immigration status, South Asian population has limited access to healthcare facilities. Due to poverty and low income, people face lack of access to reliable and affordable transportation facilities. There are very poor healthcare facilities in the areas, where immigrants live and they have not enough money to access better healthcare facilities (Misra et al, 2014, p. 1154). Bangladeshi men are highly vulnerable due to low economic status. The other poorest group is of the Pakistani people, as they have limited employment opportunities. The problem of economic status can be addressed by encouraging more employment opportunities for South Asians and providing free or affordable care facilities and transportation services.
Social: The social status of the South Asian population is significantly influenced by their cultural and religious beliefs. Lack of personal awareness and fatalistic belief is the major social barrier. South Asian people suffer from high risk of type2 diabetes because of their lifestyle, diet and cultural influence (Bhopal, 2013, p. 37). The social factors are among the significant barrier. It includes the cultural and religious aspects of the target community. The target population is also aging, which can pose a significant social barrier. For addressing this issue, government requires to provide culturally competent care and religiously sensitive care facilities to South Asians.
Technological: Technological barrier among the health care access and South Asians in UK is that due to lack of educational background and awareness people are not able to access innovative technological tools. Technological issues could be a significant barrier in the access to health care information and accessing the support groups. The low socio-economic status of South Asians they have lower access to technological awareness towards improving their health (Isaacs et al, 2016, p. 5). Technological issue can be addressed through providing technological education sessions focused on target community
Part B
Critical Analysis of Evidences
South Asian community lives in various urban locations of UK. The evidences identified in part A, informed that this population suffer significantly from type2 diabetes, which is a chronic illness and still incurable. Diabetes is often related to obesity and unhealthy lifestyle. The major risks of obesity are associated with development of diabetes and cardiovascular disease. Type2 diabetes affects various aspects of life of an individual and can significantly affect the well-being and quality of life. South Asian population is at higher risk of diabetes in comparison to remaining population of UK. The lifestyle changes has increased the risk of obesity and increased the incidence of type 2 diabetes in the community. Genetic and environmental factors are responsible for the development and prevalence of the diseases.
However, some of the other factors include sedentary lifestyle, tobacco smoking, depression and socio-economic factors. Mortality rate and co-morbidities are 14% higher in the South Asian community than general population of UK. There are very limited studies that focus on finding the appropriate approach to address the growing prevalence of type 2 diabetes in South Asian population. According to the study of Gujral et al (2013), Type 2 diabetes is the leading cause of morbidity and mortality and prevalence of type 2 diabetes is very high in South Asians in their home countries as well abroad. This health problem is continuously increasing in this population. Some of the significant factors suggested by Gujral et al (2013) include lack of physical exercise, physical activities, cultural influence, and diet and lifestyle behavior. These factors are increasing the burden of type 2 diabetes in South Asian community.
According to the reports, 366 millions of people all over the world are affected by diabetes (Whiting et al, 2011). This includes the people living in developing and developed countries as well as urban and rural population. Considerable heterogeneity is found in the prevalence of type 2 diabetes in South Asian community (Gujral et al, 2013). Prevalence of type 2 diabetes is significantly higher in the South Asian migrants in comparison to other ethnic groups in host countries. Ethnicity plays an important role in affecting the health behavior of people. This is because problems of obesity and type 2 diabetes are associated with the values, belief and perceptions of the people to engage in disease prevention programs and interventions (Rawlins et al, 2013).
Social and economic condition of the population is also responsible for potential development of the co-morbid conditions such as cardiovascular disease, depression, hypertension and other serious illness. The prevalence and the social patter of the increasing incidences of type 2 diabetes, suggest that major impact is created by the environmental factors rather than the genetic factors (Chowdhury et al, 2014, p. 259). Recently, the rapid changes have been observed in the physical activities, lifestyle behavior and dietary patters of the South Asians. Type 2 diabetes has become a major health problem, which has resulted in high disease burden. Ethnic inequality in UK has also contributed to heavy burden of type 2 diabetes in South Asians (Mako, 2013). Studies have also found the associated of type 2 diabetes with genetic factors. However, the studies conducted in relation to South Asian community are very few.
According to Mako (2013) “T2DM is a polygenic disorder with multiple genes located on different chromosomes contributing to its susceptibility. Analysis of the genetic factors is further complicated by the fact that numerous environmental factors interact with genes to produce the disorder” (p. 18). This explains that different genetic backgrounds play a significant role in the pathogenesis of the diseases. The clinical picture can be changed due to environmental factors (Bakker et al, 2013). Various studies have also examined and concluded that higher fasting insulin concentrations are found in South Asians in comparison to other ethnic groups.
Studies have significantly related the socio-economic position of the community with their health condition and heavy burden of type 2 diabetes. Socio-economic factors decide the position of the individual in the society. The socio-economic factors include education level, employment, income and wealth. The socio-economic differences are measured in terms of health according to the available opportunities for the people to maintain good health and access health care services at the time of need (Shrivastava and Misra, 2015, p. 438). Social inequalities and economic status are among the most important reasons associated with poor health, poor nutrition, polluted environment and crowded living conditions. Higher exposure to tobacco, alcohol and drugs are also significant health determinants. Study of Sacerdote et al, 2012 found that there is an inverse relationship between education and risk of type 2 diabetes. Low income of the people is also associated with higher prevalence of type 2 diabetes. Studies have found that low socio-economic status of the South Asians has lead them at greater risk of type 2 diabetes. South Asians are considered to be the disadvantaged groups with a range of risks factors that are exposing them to chronic illness of diabetes. People living in poor conditions and deprived areas are more vulnerable to various chronic diseases. It is also found that higher the deprivation level, higher is the risk of type 2 diabetes (Jayaweera and Quigley, 2010).
Community Health Development Plan
The community health development plan to address the high prevalence of type 2 diabetes in South Asian population in UK will underline various steps.
According to the definition provided by EHO, Health is considered as the holistic well-being. It included physical, social and mental well-being of the people in order to achieve optimal health. Health of the individual in the community is affected by various health determinants. Studies have associated the health and well-being of the individuals with social, economic, cultural and physical environment. Health of South Asians is also affected due to these reasons. Therefore, this health plan identified that major health determinants in South Asian population in UK are socio-economic status, stress of migration and changed lifestyle, lack of employment opportunities and low income, regulations and public policies, cultural differences and language barrier (Lucas, Murray, and Kinra, 2013).
Partnership in healthcare is a very important approach to break the traditional boundaries and form a collaborative environment to address the health issue. Health care professionals and volunteers will be provided with the training sessions so that they can learn about creating partnership with the care seekers. The target community is culturally sensitive. Therefore, the training sessions for the health care professional will include skills and educational training for developing culturally sensitive care plans for South Asians. Community development approach addresses the social and economic problems of South Asians. Community development through partnership will focus o improving social and economic progress of target community.
South Asians are the groups of people, who are highly influenced by their culture and religion. The religious and cultural belief of these people significantly affects their health behavior. Since, studies have found that these people are less likely to understand the relation of health with personal lifestyle (Lucas, Murray, and Kinra, 2013). Therefore, culturally sensitive care will be the main focus, by including social values and norms of these people in care delivery. South Asians have strong bonding with their social and family networks. Social support is very significant for them that also promotes their health behavior. People requiring health care will be treated with the help of social support. Family members and social networks will be included in the care, as they can be a great source to encourage healthy diet and life style. Qualitative studies will be carried out to understand the cultural beliefs and attitudes of the South Asians, so that screening design can be prepared.
As the evidences have demonstrated the elevated risk of type 2 diabetes in South Asian population due to many lifestyle difference among Europeans and South Asians; it is important to include lifestyle interventions. The major lifestyle modification is the inclusion of physical activity programs in multi-ethnic setting (Patel and Iliffe, 2017, p. 3). Perceived barrier and challenges to successful promotion of good health behavior has been studied. The major challenge is the resignation of acquiring healthy behavior and considering the occurrence of the disease due to the family history. Some of studies have also found that resignation occurs due to considering the occurrence of the disease as fate. Fatalism and different religious belief has made it difficult to acquire healthy behavior. This explains the significant requirement of the religious leaders in the health care interventions. Fatalism and religious beliefs of the South Asians have been reported by the healthcare professionals. It is also found that such attitude makes the healthcare professionals reluctant to advice because of poor religious understanding. Inclusion of the religious leader will help to make them understand the importance of healthy behavior and accepting lifestyle interventions (Patel and Iliffe, 2017, p. 5).
Studies have found that lifestyle can significantly influence the health behavior of the people. South Asians are considered to have high level knowledge about the role of physical activities and lifestyle associated with the aetiology of diabetes and heart diseases. However, it was also found that there was a lack of translation of knowledge in practice (Patel et al, 2015, 1123). People are aware that what the healthy diet must include, but they lack the skills to translate their knowledge in everyday practice. Therefore, community based educational programs can address the needs of the ethnic group. Education is considered as the facilitator towards adopting healthy lifestyle. Education can increase people’s awareness towards health issues and can encourage sustaining change in lifestyle. It must also include providing educational training to the healthcare providers (Patel et al, 2015, 1124).
Self management is a very significant approach to empower the patient to manage their health and get involved in their personal care. This encourages self esteem, confidence and reduced the risks of occurrence of type 2 diabetes (Patel et al, 2015, p. 59). The high risk population like the South Asians can be provided with education for diabetes management. However, it is important to understand the knowledge level, health practice, attitudes and willingness to play an active role in self-management (Wilkinson, Whitehead and Ritchie, 2014). South Asians have significant impact of culture and religion on their diet. SO, healthy diet plan can be provided through community based dietary programs. People from the community will be encouraged to take part in educational initiatives.
Evidence gathered through literature review has shown that language is a significant barrier for the people in accessing health care service and understanding the advices. This problem is mainly seen in the first generation people, who often rely on their family members to translate or interpret. Therefore, language is another significant barrier to lifestyle changes (Sohal et al, 2015). Bilingual health care professionals can play significant role in encouraging the acceptability of the interventions and promoting healthy behavior. People, who are reluctant to change the traditional norms of taking high energy diet and rejecting use of fruits and vegetable in daily diet, can also be addressed by including bilingual professionals and health care providers. The typical South Asian diet is filled with many dietary imbalances. The effect of unbalanced diet has increased due to migration. With the help of bilingual community workers, volunteers and professionals this problem can be addressed.
S-Strength: The strength of the community based approach is that it addresses the whole community. Community led approach is very important for the wider community based development (Dailly and Barr, 2008). The strength of this approach is that it is focused on bringing the social change, by addressing the situation of the socially disadvantaged people. Since, there are various factors associated with disadvantage and inequality, community based development approach will help in addressing the health issue, which is collectively experienced by number of people. Therefore, this strategy has the strength of influencing change.
Weakness: Community based project for the South Asian population in UK is a new approach. However, it is applied in UK, but not on very sustainable level. Therefore, it requires the more analysis of the community based initiatives in UK. The approach has the potential to address health care inequalities, but perceived inequalities are not addressed through this approach. The approach also requires to analysis the international health policies, which are used to address the needs of different ethnic groups. The weakness lies in developing the framework through strategies developed by Ottawa Charter principles.
Opportunities: Community based project is based on supporting communities, who are experiencing poor health due to various health determinants. Some of the good opportunities that have been spotted are that the health of South Asian community can be significantly addressed by changing the healthcare service delivery system, improving accessibility through free transportation services, free consultations and medications, and brining changes in the migration policies. Technological changes and promotions can also work as important tool to address the issue of lack of health literacy in South Asians. Lifestyle changes are supported with many evidences. Bringing lifestyle changes in people through various strategies can be successful in improving health of South Asians and reducing prevalence of type2 diabetes.
Threats: The main threats in applying community based approach are the ingrained cultural and religious beliefs of South Asians. Change or altering their belief system is very difficult. Lack of appropriate implementations of the procedures can result in the failure of the community based approach. Fatalism and resignation can be the important threats that are required to be addressed through evidence based methods.
Conclusion
The aim of report was to address the key public health issue in the local ethnic community of UK. Paper identified that South Asian population in UK is the largest ethnic group. During writing this report that knowledge obtained was that South Asian community is considered to ideal to deliver the community based approach to identify major health issue and challenges. It is because this community is the largest ethnic community of UK and requires the more sophisticated intervention to reduce major health issues. Type 2 diabetes is found as the major health problem prevailing in the South Asian community of UK. It was also found that by addressing the health problems in the ethnic minorities and providing effective interventions can significantly reduce the healthcare related financial burden on the country.
This was the major learning that was gained while preparing the report. It also helped to get knowledge about significance of religion and culture in healthcare. It was examined that current interventions are not able to address all the barriers. But, it was learned that some significant facilitators are, using strength of the target community in reducing disease burden. South Asian community has strong bonding among themselves, their family members and peers. This can significantly help in managing health of people, by promoting family and peer support. PEST and SWOT analysis helped to plan the community based project, and understand various facilitators and barriers.
Ambady, R., Snehalatha, C., Samith Shetty, A. and Nanditha, A., 2013. Primary prevention of Type 2 diabetes in South Asians challenges and the way forward. Diabetic Medicine, 30(1), pp.26-34.
Amin, A., Ali, A., Altaf, Q.A., Piya, M.K., Barnett, A.H., Raymond, N.T. and Tahrani, A.A., 2017. Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine.
Bakker, L.E., Sleddering, M.A., Schoones, J.W., Meinders, A.E. and Jazet, I.M., 2013. MECHANISMS IN ENDOCRINOLOGY: Pathogenesis of type 2 diabetes in South Asians. European journal of endocrinology, 169(5), pp.R99-R114.
Bhopal, R.S., 2013. A four?stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations. Diabetic Medicine, 30(1), pp.35-42.
Chowdhury, R., M Venkat Narayan, K., Zabetian, A., Raj, S. and Tabassum, R., 2014. Genetic studies of type 2 diabetes in South Asians: a systematic overview. Current diabetes reviews, 10(4), pp.258-274.
Cross-Bardell, L., George, T., Bhoday, M., Tuomainen, H., Qureshi, N. and Kai, J., 2015. Perspectives on enhancing physical activity and diet for health promotion among at-risk urban UK South Asian communities: a qualitative study. BMJ open, 5(2), p.e007317.
Gujral, U.P., Pradeepa, R., Weber, M.B., Narayan, K.M. and Mohan, V., 2013. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Annals of the New York Academy of Sciences, 1281(1), pp.51-63.
Lucas, A., Murray, E. and Kinra, S., 2013. Heath beliefs of UK South Asians related to lifestyle diseases: a review of qualitative literature. Journal of obesity, 2013.
Isaacs, T., Hunt, D., Ward, D., Rooshenas, L. and Edwards, L., 2016. The inclusion of ethnic minority patients and the role of language in telehealth trials for type 2 diabetes: A systematic review. Journal of medical Internet research, 18(9).
Mahmood, B., Afshar, R. and Tang, T.S., 2017. Recruitment and Retention of South Asian Ethnic Minority Populations in Behavioral Interventions to Improve Type 2 Diabetes Outcomes. Current Diabetes Reports, 17(4), p.25.
Mako, R.S., 2013. Ethnic inequalities in health: why is the prevalence of type 2 diabetes higher among South Asian immigrants? (Master’s thesis, Høgskolen i Oslo og Akershus. Fakultet for samfunnsfag).
Misra, A., Ramchandran, A., Jayawardena, R., Shrivastava, U. and Snehalatha, C., 2014. Diabetes in South Asians. Diabetic Medicine, 31(10), pp.1153-1162.
NHS Diabetes Prevention Programme NHS DPP. (2016). Accessed: 23 March 2017 https://www.england.nhs.uk/ourwork/qual-clin-lead/diabetes-prevention/
Patel, M., Phillips-Caesar, E. and Boutin-Foster, C., 2012. Barriers to lifestyle behavioral change in migrant South Asian populations. Journal of immigrant and minority health, 14(5), pp.774-785.
Patel, N.R., Chew-Graham, C., Bundy, C., Kennedy, A., Blickem, C. and Reeves, D., 2015. Illness beliefs and the sociocultural context of diabetes self-management in British South Asians: a mixed methods study. BMC family practice, 16(1), p.58.
Patel, V. and Iliffe, S., 2017. An exploratory study into the health beliefs and behaviours of British Indians with type II diabetes. Primary Health Care Research & Development, pp.1-7.
Patel, N., Stone, M.A., Hadjiconstantinou, M., Hiles, S., Troughton, J., Martin-Stacey, L., Daly, H., Carey, M., Khulpateea, A., Davies, M.J. and Khunti, K., 2015. Using an interactive DVD about type 2 diabetes and insulin therapy in a UK South Asian community and in patient education and healthcare provider training. Patient education and counseling, 98(9), pp.1123-1130.
Rawlins, E., Baker, G., Maynard, M. and Harding, S., 2013. Perceptions of healthy eating and physical activity in an ethnically diverse sample of young children and their parents: the DEAL prevention of obesity study. Journal of Human Nutrition and Dietetics, 26(2), pp.132-144.
Sacerdote, C., Ricceri, F., Rolandsson, O., Baldi, I., Chirlaque, M.D., Feskens, E., Bendinelli, B., Ardanaz, E., Arriola, L., Balkau, B. and Bergmann, M., 2012. Lower educational level is a predictor of incident type 2 diabetes in European countries: the EPIC-InterAct study. International journal of epidemiology, 41(4), pp.1162-1173.
Shrivastava, U. and Misra, A., 2015. Need for ethnic-specific guidelines for prevention, diagnosis, and management of type 2 diabetes in South Asians. Diabetes technology & therapeutics, 17(6), pp.435-439.
Sohani, Z.N., Deng, W.Q., Pare, G., Meyre, D., Gerstein, H.C. and Anand, S.S., 2014. Does genetic heterogeneity account for the divergent risk of type 2 diabetes in South Asian and white European populations?.
Sohal, T., Sohal, P., King-Shier, K.M. and Khan, N.A., 2015. Barriers and facilitators for type-2 diabetes management in South Asians: a systematic review. PloS one, 10(9), p.e0136202.
Wilkinson, A., Whitehead, L. and Ritchie, L., 2014. Factors influencing the ability to self-manage diabetes for adults living with type 1 or 2 diabetes. International journal of nursing studies, 51(1), pp.111-122.
Wilkinson, E., Randhawa, G. and Singh, M., 2014. Quality improvements in diabetes care, how holistic have they been? A case-study from the United Kingdom. International journal for equity in health, 13(1), p.29.
Wallia, S., Bhopal, R.S., Douglas, A., Bhopal, R., Sharma, A., Hutchison, A., Murray, G., Gill, J., Sattar, N., Lawton, J. and Tuomilehto, J., 2013. Culturally adapting the prevention of diabetes and obesity in South Asians (PODOSA) trial. Health promotion international, p.dat015.
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download