Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients’ self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients’ T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument ‘Cultural Conflict’ was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours. Keywords: type 2 diabetes; South Asian; culture; conflict; healthcare; qualitative; evidence synthesi

A grounded theory of type 2 diabetes prevention and risk perception

Objective Type 2 diabetes (T2D) prevention programmes should target high‐risk groups. Previous research has highlighted minimal engagement in such services from South Asian (SA) people. Given SA's elevated risk of T2D, there is a need to understand their perceptions, risks, and beliefs about T2D. Design This study aimed to assess T2D risk perception within a community sample of SA people using Grounded Theory methodology. Specifically, health beliefs were assessed, and we explored how these beliefs affected their T2D risk perceptions. Method Twenty SA participants (mean age = 38 years) without a diagnosis of T2D were recruited from community and religious settings across the North West of England. In line with grounded theory (Strauss & Corbin, 1990, Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications), data collection and analysis coincided. Results The superordinate category of Culturally Situated Risk Perception incorporated a complex psychological understanding of the formation of T2D risk perception, which takes into account the social, cultural, and community‐based environmental factors. This superordinate category was explained via two core categories (1) Diminished Responsibility, informed by sub‐categories of Destiny and Heredity, and (2) Influencing Healthy Lifestyle Behaviours, informed by sub‐categories of Socio‐cultural and Environmental. Conclusion This study investigated risk perception of T2D within the SA community. When considering health prevention in the context of an individual’s culture, we need to consider the social context in which they live. Failure to acknowledge the cultural‐situated T2D risk perception relevant to health promotion and illness messages may account for the issues identified with health care engagement in the SA population

Health professionals interface with cultural conflict in the delivery of type 2 diabetes care.

OBJECTIVE: This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN: Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES: Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS: A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS: The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients

Differences in public's perception of air quality and acceptability of a clean air zone : A mixed-methods cross sectional study

Background: Air pollution is a major cause of morbidity and mortality. Clean Air Zones (CAZs) which restrict the entry of polluting vehicles in targeted areas have been identified as potentially effective in improving health and reducing air pollution; however, their implementation can be controversial. Methods: A cross-sectional survey was completed by 1949 respondents who lived or worked in Bradford, a multi-cultural deprived city in England, between April and December 2021. Of these, 1137 were recruited from the longitudinal Born in Bradford (BiB) family cohort (families with children born in the city during 2007–2011) and 812 were from the general public. Bradford is the seventh largest metropolitan district in England and Wales with a population of over half a million mainly white British and Pakistani origin. The BiB families cohort and the general public respondents were used for descriptive analysis of perception of air quality and acceptability of CAZ, then the relationship between participants responses with demographic characteristics were investigated using the BiB families cohort. Outcomes included perceptions of air quality and acceptability of the CAZ supplemented by free-text questions. Thematic analysis was used to code free-text data. Descriptive analyses were performed on the entire sample. Latent class analysis was used to characterise participants was performed in the BiB dataset for whom detailed existing socio-demographic data were available. Results: The majority of participants (67%) considered improving air quality in Bradford as extremely important; 70% supported implementation of the CAZ. Three latent classes were identified within the BiB sample: deprived white British families (25%), more affluent white British families (32%) and deprived Pakistani-origin families (43%). Deprived white British (OR = 0.54, 95% CI: 0.34 to 0.84) and more affluent white British families (OR = 0.53, 95% CI: 0.36 to 0.79) were less likely to say the air quality was good/excellent when compared with deprived Pakistani-origin families. Affluent White British families were more likely to support the CAZ compared with deprived white British families (OR = 2.24; 95% CI: 1.55. to 3.25) and deprived Pakistani-origin families (OR = 2.06, 95% CI: 1.50 to 2.85). Qualitative analysis suggested that a perceived lack of cohesion in the policy and concerns about financial impacts drove negative attitudes. Conclusion: Families in Bradford were generally supportive of the planned CAZ and efforts to reduce pollution; however, support was weaker in more deprived communities. Pakistani-origin communities living in deprived areas perceived air quality as better than other groups. Tailored approaches to communicate about the proposed benefits of policies such as CAZ prior to implementation may be an important way to increase acceptability amongst vulnerable groups

National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland

Background: Currently no national standards exist for the prevention of surgical site infection (SSI) in cardiac surgery. SSI rates range from 1% to 8% between centres. Aim: The aim of this study was to explore and characterize variation in approaches to SSI prevention in the UK and the Republic of Ireland (ROI). Methods: Cardiac surgery centres were surveyed using electronic web-based questionnaires to identify variation in SSI prevention at the level of both institution and consultant teams. Surveys were developed and undertaken through collaboration between the Cardiothoracic Interdisciplinary Research Network (CIRN), Public Health England (PHE) and the National Cardiac Benchmarking Collaborative (NCBC) to encompass routine pre-, intra- and postoperative practice. Findings: Nineteen of 38 centres who were approached provided data and included responses from 139 consultant teams. There was no missing data from those centres that responded. The results demonstrated substantial variation in over 40 aspects of SSI prevention. These included variation in SSI surveillance, reporting of SSI infection rates to external bodies, utilization of SSI risk prediction tools, and the use of interventions such as sternal support devices and gentamicin impregnated sponges. Conclusion: Measured variation in SSI prevention in cardiac centres across the UK and ROI is evidence of clinical uncertainty as to best practice, and has identified areas for quality improvement as well as knowledge gaps to be addressed by future research

Evaluating Type 2 Diabetes Risk Perception in the British South Asian General Population: A mixed methodology approach for intervention development

Type 2 Diabetes (T2D) is a significant public health concern with a high prevalence within the UK South Asian (SA) population. Previous research has highlighted that SA people ‘s behaviour might be influenced by Culture and Genetic factors. However, studies are still on-going to find out why the SA ethnic group has a higher prevalence compared to other ethnic groups. There is limited research exploring Risk Perception (RP) of T2D in the SA community. The overall PhD aim was to understand the complexities of RP in the SA community and to develop and test an intervention to change RP and hence improve T2D prevention behaviours for the SA general population. This PhD thesis presents a number of studies which each explored specific aspects of RP and preventative behaviours in the SA population. New understanding has been created through the completion of a literature review evaluating the previous literature on T2D RP and prevention. In addition to this, a combination of Quantitative and Qualitative studies (mixed methods) explored multiple perspectives of RP and prevention behaviours in the SA population. Each study offered a unique contribution to the evidence-base and presented new knowledge, to develop a thorough and comprehensive understanding of the overall PhD aim. Overall, preventative behaviours are influenced by various dimensions of RP, predominantly Locus of Control (LoC). The findings are discussed with reference to psychological theories. Based on these findings, and in collaboration with a range of stakeholders, an intervention was developed using the Medical Research Council (MRC) framework and the ‘person-based’ approach. A call for further research to roll-out the intervention within a real-world context is required and understand the relevance of this research applied to T2D prevention settings

Dynamic model of a thermal solar collector.

In the paper a dynamic model for simulating the behavior of a thermal solar collector is presented. The collector is unglazed with a metal receiving pipe thermally linked to fins and presents thermal insulation in the back side and surface. The main characteristic of the proposed model is its capability of simulating the thermal performances for any given time discretization or collector axial discretization. The routine implemented is such to generate the system of partial differential equations (in matrix form) which dimension depends on the number of axial nodes assumed (nx); the system is then numerically integrated upon the imposed discretization time (∆t). The model realized is “White Box” (all phenomena occurring within the component are studied referring to physical equations) and “State Determined” (state variables can be defined: energy storage is possible and heat can be accumulated both in the metal absorber and in the Heat Transfer Fluid). The collector pipe is split up into nx segments (axial discretization) with length ∆x; for each of the segments energy conservation equations are applied to both the metal pipe and the Heat Transfer Fluid flowing within it. The component therefore presents a 2 node distribution in the longitudinal direction. The model is realized within Simulink® and is based on a Matlab® S-Function where all the equations are implemented in parameterized form and integrated. Results of are proposed from dynamic simulations with different degrees of axial discretization of the system and with time varying inputs

Internal Combustion Engines bottoming with Organic Rankine Cycles. A thermodynamic analysis.

In the paper a specific thermodynamic analysis is presented in order to efficiently match a vapour power cycle to a stationary internal combustion engine with a rated power output of 3MWe. Three different working fluids are considered to represent the main classes of fluids with reference to the shape of the vapour lines in the T-s diagram: overhanging, nearly isoentropic and bell shaped. A parameterized analysis is first conducted in order to determine the optimal evaporating pressure. Then three different cycles setups are considered: a simple cycle with use of only hot exhaust gases from the engine, a simple cycle with use of hot exhaust gases and engine cooling water to preheat the organic fluid and a regenerated cycle. A second law analysis of the cycles is performed with reference to the heat sources available in order to determine the best fluid and cycle configuration to be employed and the main parameters of the thermodynamic cycle as well as the overall efficiency of the combined power system