Abstract
Type II Diabetes Mellitus (T2DM) is a non-communicable condition that results in significant health complications, increasing mortality, and resource demands and financial burdens on health systems and communities globally. An alarming increase of T2DM incidence is seen in the Asian population globally. Migration is one of the contributing factors to T2DM's development and progression due to migrants' changes in psychosocial and socioeconomic circumstance, physical activity levels and dietary habits while living in a foreign country.
This integrative literature review (ILR) seeks to explore the challenges experienced by Asian immigrants in managing T2DM. The findings may enable healthcare professionals to identify ways to better support patients' self-management, and to identify areas for service improvement to deliver culturally appropriate and patient-centred T2DM management services.
A Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) tool was used to guide the literature search and to select articles that meet the inclusion and exclusion criteria. Twelve included articles were appraised by using the Joanna Briggs Institute (JBI) appraisal tools, and their data was extracted by using the JBI qualitative data extraction tool. Data was analysed through reflexive thematic analysis (TA) with an inductive approach. This study was approved by the University of Otago (UO) Research Proposal Committee.
Four themes including communication and information barriers, lack of support, cultural influences and stresses of living in a new country were found. Seven interrelated subthemes were also found. Language barriers experienced by Asian immigrants were significant obstacles in communicating with healthcare providers and seeking health information. Lack of culturally appropriate health services as well as a lack of social, family and financial support leads to a lonely and difficult journey to manage T2DM effectively. Cultural dietary and medication taking behaviours clashed with the host countries' available resources and guidelines. The life of an immigrant also posed indirect negative impacts on the Asian immigrants' ability to manage T2DM.
The findings have highlighted the need for understanding and support from multidisciplinary teams and multi-level service providers. The key recommendations include: providing culturally appropriate language support through multiple channels, providing comprehensive information regarding the health system and supporting services, encouraging cultural competence awareness and providing training to healthcare providers, providing individualised dietary advice, and supporting Asian immigrants to overcome various post migration challenges. Limitations of this ILR include limited Asian sub-groups, limited host countries in the eligible studies, and a narrow age range of the participants.