Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England
Abstract
:1. Introduction
Evaluation Design
2. Materials and Methods
2.1. Data Collection
2.2. Data Analysis
2.3. The Theory of Change
2.4. Patient and Public Involvement
3. Results
3.1. The Study Participants
3.2. Identified Themes
3.2.1. Individual and Group Support for Self-Management
“they told me to watch my diet, watch what I eat-plenty greens, fewer carbs, and to exercise, and that will keep my blood sugars down”.
“I was invited to some talks, but I didn’t go. I was overweight and struggled to walk, and nobody could take me in their car” (Asian British Male, 65+ years).
“I was signposted to DESMOND. The programme affirmed things I know. It was useful”
“…very disjointed, and it’s difficult to find out about that. I tended only to find out about things by chance, in some instances through desperation” (White British Male, 65+ years).
“My GP told me to lose weight and stop eating rice and chapati and other things. My sister also had diabetes a few years before, and she also told me some tips”.
“At present, I don’t get any [information]. I am just living with the original information I was given about diet and taking one tablet until today. It concerns me because I don’t know whether my blood sugar is gone” (White British Male, 65+ years).
“I think it has to be the internet, to be honest. Yeah. I found a lot on the internet about various foods and how they affect your blood sugars”.
“And it also happened that she [neighbour] had diabetes. And she says to me, “oh, there’s a group going on at [name of VCSE]”… And I felt renewed, elated because it was a group that, that there were other people with the same diagnosis, the same struggle”.
3.2.2. Trusted Services and Relationships across the Community
“Diabetic nurse.... Well, it’s just generally sent me for bloods, look at my feet. Quick chat. Jobs a good ‘un!” (Unknown).
“at the moment, due to the pandemic, no one [is supporting with diabetes management]; that’s what I feel let down by because I think if you’ve got something like diabetes, I should be getting support”.
“the information I was given was appropriate for me. I visited the nurse at the doctor’s surgery every 3 months for my bloods, she was very good, and I developed a good relationship with her. She told me about exercise classes in the area and also told me about health walks”.
“my mental health is really bad due to not managing diabetes. It has affected my life. I try to avoid my GP appointments because I know I struggle to manage my diabetes”.
“I get most of my information now from community hub, I go for the keep fit sessions, and they do some health information cafes where they talk about healthy things to eat and portion sizes. They also tell you what food to avoid if you have diabetes. It has been a good refresher for me”. (Pakistani Female, 65+ years).
3.2.3. Long-Term Engagement with Services
“I had a couple of things that I spoke to a doctor about: dehydration, night sweat, that kind of thing. And they did a blood test. So, it was a blood test that revealed. Like yeah, because yeah, my mom’s diabetic. And then I’ve always known it was coming. Yeah, it was just a case of, obviously, two brothers. And I was never sure if it was going to be me or them too. But it seems to have come down the female line” (White British Female, 56–64 years).
“the doctor sent me for blood tests, and they came back showing I had diabetes. I was so shocked and upset. I didn’t even know young people got diabetes”.
“I was very, very upset when I found out I had diabetes. I was scared that I would not be able to eat all the food that I loved and worried about what I would eat”.
“The first few years were very tough. I stopped eating out and I stopped visiting parties and friends because I was worried that they would offer me food and I wouldn’t be able to eat anything. I was also scared that people would be watching me and watching what I eat. This made me isolated and depressed, and I developed social anxiety. It has taken me years to get over this, and now I feel I am confident and in control”.
“I didn’t really take on board or understand how serious diabetes is. I thought if I take my tablets, watch my diet, and look after my feet, I’d be ok…. but talking to people, they tell me about problems with their kidneys and blood flow to their legs, lots of problems. I hope I don’t get any of this” (Black Caribbean British Female, 65+ years).
3.2.4. Sociocultural Context of Diet and Nutritional Choices
“My husband was very helpful and supportive...he helped me reduce some weight…I realised that when I cut down on sugary stuff and started eating less rice and chapati, my weight dropped by itself. I also started walking a lot, and me and my husband would go for walks after the evening meal.”
“Anyway, apparently, you’re not supposed to have carbohydrates and sugars, which is, like, most of what I eat, potatoes, bread”.
“I eat a lot of onions and green onions and leeks and that kind of thing…very particular triggers and learning how to regulate how much fruit I eat, shouldn’t eat too much fruit, certain fruits you should avoid, and so on. Yeah, I learned a lot from the internet”.
3.2.5. Multifaceted Adaptation to the Long-Term Condition
“The information I got was from …. a really good group. You know, it’s, it helps me really, to manage.. day -to-day menu, day-to--to-day exercising, everything. I mean, every…everyone that was there was going through the same thing. I mean, the shared experience, we all shared our experience, you know, because everybody was different there. And they understood what everybody else had going on. So, it helped”.
“I immediately started walking and eating more fruits and vegetables and lost a lot of weight. I controlled it via diet for at least 2 years. After 2 years, I was put on medication. I am still learning about things even at this stage. I have stopped eating all sugary stuff; I have a lot of self-control” (Pakistani Female, 65+ years).
“I also tried some bitter drinks that people in Pakistan drink when they have diabetes, that helps me keep my sugar level under control, and I also eat bitter gourds, that is a very bitter vegetable. I also put cinnamon in my tea as I have heard that it helps lower when levels are high. I am very careful I don’t let my levels go high”.
“So, there’s nowt [nothing] he’s going to do for me, says you…you’ve got diabetes, and you smoke. So anyway, so basically, I’m just left here with a perforated eardrum,” said a White British Male (56–64 years).
3.2.6. Shared Community Support Network
“There is a need for a lot of improvement culturally because then if we introduce…traditionally if there is one person gets the information, he spread it out to the [the rest of the community]… a big job to for the people’s awareness in mainly an Asian community”.
“we need to meet up regularly and consistently. Peer support and good communication” (Black British Caribbean Male, 56–64 years).
“A safe place, a comfortable place…. I’d like to make a place where anybody can come. You don’t have to talk about it if you just want to come to sit. Have a cup of coffee—a bit like the men’s group”.
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Sex (Male/Female) (%) | 14/16 (47%/53%) | |
---|---|---|
Age (years) (%) | 26–45 | 4 (13%) |
46–55 | 8 (27%) | |
56–65 | 5 (17%) | |
65+ | 9 (30%) | |
Unknown | 4 (13%) | |
Ethnicity (%) | Asian or Asian British | 4 (13%) |
Black or Black British | 7 (23%) | |
Mixed—Other | 3 (10%) | |
White—British | 11 (37%) | |
White—Other | 1 (3%) | |
Unknown | 4 (13%) | |
Education status (%) | No formal qualifications | 2 (7%) |
Up to GCSE or equivalent | 5 (17%) | |
AS/A level or equivalent | 2 (7%) | |
Apprenticeship | 1 (3%) | |
Further Education | 6 (20%) | |
Undergraduate degree | 4 (13%) | |
Postgraduate degree | 1 (3%) | |
Prefer not to say/unanswered | 9 (30%) | |
Time since diagnosis (years) (%) | 0–4.9 | 13 (43%) |
5–9.9 | 2 (7%) | |
10–14.9 | 5 (17%) | |
15–19.9 | 1 (3%) | |
20+ | 2 (7%) | |
Prefer not to say/unanswered | 7 (23%) | |
English Indices of Multiple Deprivation (2019) [by postcode data] (%) | 0–20% most deprived | 14 (47%) |
21–50% | 7 (23%) | |
51–80% | 1 (3%) | |
20% least deprived | 2 (7%) | |
Prefer not to say/unanswered | 6 (20%) |
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Nield, L.; Bhanbhro, S.; Steers, H.; Young, A.; Fowler Davis, S. Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England. Healthcare 2023, 11, 2499. https://doi.org/10.3390/healthcare11182499
Nield L, Bhanbhro S, Steers H, Young A, Fowler Davis S. Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England. Healthcare. 2023; 11(18):2499. https://doi.org/10.3390/healthcare11182499
Chicago/Turabian StyleNield, Lucie, Sadiq Bhanbhro, Helen Steers, Anna Young, and Sally Fowler Davis. 2023. "Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England" Healthcare 11, no. 18: 2499. https://doi.org/10.3390/healthcare11182499
APA StyleNield, L., Bhanbhro, S., Steers, H., Young, A., & Fowler Davis, S. (2023). Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England. Healthcare, 11(18), 2499. https://doi.org/10.3390/healthcare11182499