Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe. Issue 11 (6th May 2021)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: Diabetic medicine. Volume 38:Issue 11(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-05-06
• Subjects: cultural adaptation -- diabetes -- diet -- dietary -- exercise -- interventions -- South Asian -- realist review; Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14584
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: 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'. Methods: 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. Results: 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). Conclusions: 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.