Support systems for and barriers to diabetes management in South Asians and Whites in the UK: qualitative study of patients' perspectives

Objectives: To explore experiences of UK-based South Asian and White patients with diabetes in relation to their support systems for and barriers to diabetes management. Design: Qualitative study (semistructured interviews analysed using a form of Interpretative Phenomenological Analysis). Participants: 20 outpatients with diabetes (12 British South Asians and 8 British Whites) with either good or poor glycaemic control. Setting: Hillingdon Hospital, Uxbridge, UK. Results: Qualitative analysis revealed distinct themes for the two ethnic groups. For the South Asian participants, challenges surrounding diet management and social stigma attached to having diabetes were the two predominant barriers to effective diabetes management. Support from immediate family members was commonly reported as a strong support system for optimising diabetes management by the South Asian sample in addition to the perceived positive impact of religion (healing power of prayer), the valuable informational support from their diabetes-care team, patient leaflets and diabetes magazines. Similar to the South Asians, adhering to dietary recommendations was the most difficult aspect of diabetes management for the White participants followed by the inconveniences surrounding injecting insulin. The hospital diabetes-care team was considered as the most effective support system for diabetes management by the White sample and interestingly, this was the only dominant theme in their reported sources of support. Conclusions: Both South Asian and White participants emphasised adherence to dietary recommendations as the most difficult aspect of living with diabetes. In addition, social stigma attached to diabetes was a prominent concern among South Asian participants that seemed to have a significant negative impact on their diabetes control and overall management. Given South Asian patients' reliance on their family for the management of their condition, interventions targeting improved diabetes outcomes in this population may prove more successful if they are designed to involve significant family members.