A SYSTEMATIC REVIEW OF TYPE 2 DIABETES SELF-CARE PRACTICES IN ETHIOPIAN IMMIGRANTS

Aim: The aim of this review was to explore the published literature on the relationship of acculturation and self-care practices of older Ethiopian immigrants with Type 2 Diabetes (T2D) and to use findings to suggest future studies that would identify specific factors that inhibit self-care behaviors among this population.

Background: Ethiopian Immigrants represent the second largest African Immigrant population with over half a million residing in the United States (US) (US Census, 2012). Among studies that have considered Ethiopian immigrants specifically, there is evidence that Ethiopian immigrants have a higher T2D prevalence associated with duration in the U.S.  Self-care practices are essential components of T2D disease management that prevent T2D related complications. However, given the many operationalizations of acculturation, conclusive evidence of the relationship between acculturation and self-care practices among this group is still lacking.

Methods: A systematic review using PubMed, Medline, EMBASE and CINHAL was carried out exploring a cross-cultural relationship between acculturation and self-care practices by examining national and international studies involving immigrants. All study designs (qualitative and quantitative) were eligible, and no restriction was put on the date of the studies. Analyses examined the extent to which measures of acculturation (i.e., acculturation score, years in the United States, and language use) were associated with self-care practices and the immigrant group. Studies of self-care practices included those that tested one or more of several measures (i.e., medication adherence, dietary acceptability, exercise patterns, and/or glycemic control).

 

Results: The majority of the studies indicate some consistent relationships among studies done with Ethiopian immigrants who reside in Minnesota, Canada, and Israel, as well as Mexican, Asian, Caribbean, Nigerian, and Somali immigrants who reside in the US. A pattern is noted among studies where the less one is acculturated the poorest his/her dietary adherence, glucose monitoring, and exercise practices. Studies also indicate an inverse relationship between medication adherence and acculturation, making it the least challenging of the self-care practices. Additional observed individual factors include educational status, age, perceived severity of the disease, lack of awareness of how to follow diet plan, and longer duration with the disease. Due to variations in the location of studies, small sample sizes, cultural variability, and measurement bias (i.e. self-reported self-care practices), the validity of some of the studies are questioned. No study included all the variables mentioned in the search methods which made finding the patterns of the relationship difficult. Therefore there is no conclusive statement to be drawn on whether acculturation affects self-care practices of T2D among older Ethiopian immigrants.

Implications and Conclusion: Findings from this review are inconclusive of the influence of acculturation on self-care practices of T2D specific to older Ethiopian immigrants, while confirming the relationship exists cross-culturally. A pattern was noted among studies such that the less acculturation, the poorer the dietary adherence, glucose monitoring, and the less exercises. Investigating barriers to self-care practices of older Ethiopian immigrants will allow health care practitioners to implement culturally-sensitive disease management interventions by acculturation status.