Collaborative communitY based education program to reduce Inequalities in the uptake of diabetes screening among Minority Ethnic peopLe in WaLes: A Phase I feasibility study (CYMELL)

Aim of the research:

To develop a ‘One-stop diabetes shop’ to meet the educational needs of people from ethnic minorities with diabetes in Wales and to increase their uptake of screening for complications in their eyes, feet and kidneys.

Background:

The number of people diagnosed with diabetes is increasing worldwide. Unfortunately, people from ethnic minorities are at greater risk – up to five times more likely to develop diabetes than those who are ‘white’; and they develop diabetes at a younger age. The complications of diabetes are harmful and costly to treat. To prevent these complications, the NHS has nine ways of testing and screening people with diabetes: three are blood tests; another is whether they smoke; and the other five check their weight, blood pressure, eyes, feet and urine. In 2019-2020, only 42% of people in Wales with Type 2 diabetes had received all these tests. Moreover, people from ethnic minorities are especially unlikely to get these checks. So, finding new ways of encouraging them to attend for these checks would reduce the risk of complications, especially blindness, amputations and needing kidney dialysis.

What we hope to achieve:

Working with people with diabetes and their health workers, and leaders in ethnic communities, we will co-design ‘One-stop diabetes shop’ with educational materials appropriate to ethnic communities and available in a wide range of languages along with short animations known as GIFs (Graphics Interchange Formats). We will find settings for these one-stop shops that are familiar to ethnic minorities, and easily accessible by them. We will assemble teams including a diabetes nurse, a podiatrist, a retinal photographer, and ethnic community leaders and workers, to run these one-stop shops which will include checks for eyes, feet and kidneys. We aim to show that this patient-friendly approach has real potential to increase the number who attend for screening and possibly improve their health.

Research methods:

We will pilot, 'One-stop diabetes shops' in six practices in Swansea, Cardiff and Wrexham (Welsh Local Authorities with high proportions of ethnic minorities) who have collaborated with applicants in successful previous trials. This will enable us to test the feasibility of, and plan for, a future all - Wales trial (which might include up to 30 general practices in 10 Local Authorities) to evaluate rigorously whether one-stop shops do indeed improve the care of diabetes in ethnic minorities.

Public involvement:

We will involve people with diabetes from ethnic minorities and people with experience of engaging with ethnic minorities from start to finish of the project. They have helped us to design this proposal and will help us develop educational materials, design the one-stop shop, and publicise the potentially influential findings. We will involve ethnic community leaders in these tasks, especially in encouraging patients to attend the one-stop shops.

Dissemination:

Once our findings are clear, we will share them with all organisations committed to the health and welfare of ethnic minorities and similar marginalised groups, notably asylum seekers and refugees.

Our patient and public members will lead dissemination to the wider public through open events to enhance understanding. We will also seek early scientific validation through publication in peer reviewed open access journals that recognise the importance of pilot studies in developing new approaches.