Transcript Collaborative Research and Community Involvement: Working

'Evaluation of Interventions for
CC healthcare:
Cui Bono - who benefits'
Mark R D Johnson
UK Centre for Evidence in Ethnicity Health &
Diversity
Mary Seacole Research Centre
NHS Specialist Library for Ethnicity & Health
The Task Force on MFCCH & COST-HOME,
REGGIO EMILIA: March 2009
Measurement of Outcomes
• Prof. Johnson will reflect on the growing 'user
involvement' tradition in research, and the issues
involved in extending this tradition to working with
minority ethnic / migrant communities. Examples will
primarily be drawn from public and clinical health and
housing, and disability issues. He will propose a
classification of involvement, and illustrate his talk with
examples where the involvement of minority 'users' has
significantly improved the quality of research and led to
service developments improving welfare.
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i.e. what is the objective and do the
migrant/minorities benefit or is it a sham?
Insider interviewing?
• Topic of the Meeting: Many interventions have been
devised which aim to improve the health of migrants and
ethnic minorities, their access to health care, or the
quality of the care services provided to them. However,
relatively little research has been carried out to assess
the effectiveness of these interventions. In these days of
"evidence-based medicine", such research surely
deserves a much higher priority. This meeting will
discuss the research that has been carried out so far and
its findings; difficulties in carrying out evaluations; ways
of overcoming these difficulties; and the directions which
future research and policy should take.
A meta-analysis of psycho-behavioral obesity
interventions among US multiethnic and minority adults.
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The present review examines efficacious psycho-behavioral interventions in preventing
weight gains or reducing weight among US multiethnic and minority adults as few
studies were conducted to review such interventions to date.
METHODS: Data were examined from 24 controlled intervention studies, representing
23 programs and involving 13,326 adults. Studies were identified through manual and
online search of databases that include MEDLINE, Academic Search Premier, ERIC,
PsycARTICLES, SPORTDiscus, and CINAHL Plus.
RESULTS:
Whereas one-component (n=5, d=0.08, 90% CI=-0.04, 0.35) and two-component
interventions (n=13, d=0.22, 90% CI=0.05, 0.40) showed a low mean effect size,
three-component interventions (n=6, d=0.52, 90% CI=0.39, 0.65) showed a moderate
effect size. Interventions conducted in individual sessions (n=15, d=0.40, 90%
CI=0.24, 0.56) showed a higher mean effect size than group interventions (n=9,
d=0.08, 90% CI=-0.04, 0.30) although the confidence intervals overlapped.
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CONCLUSIONS: The study results indicate that future obesity prevention
interventions targeting multiethnic and minority adults might benefit from
incorporating individual sessions, family involvement, and problem solving
strategies into multi-component programs that focus on lifestyle changes.
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Seo DC, Sa J.
Prev Med. 2008 Dec;47(6):573-82.
Diabet Med. 2009 Jan;26(1):40-4.
Examining the effectiveness of a peer-led education programme for Type
2 diabetes and cardiovascular disease in a Bangladeshi population.
Choudhury SM, Brophy S, Fareedi MA, Zaman B, Ahmed P, Williams R.
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School of Medicine, Swansea University, Swansea, Wales.
AIMS: The aim of this study was to assess an adapted version of the X-PERT
Programme for Type 2 diabetes within a Bangladeshi population. METHODS:
Bangladeshi adults, living in the UK, with Type 2 diabetes participated in a
diabetes educational session based on an adapted version of the X-PERT Programme.
Participants attended a session, led by a trained peer educator and carried out
in Sylheti. All participants who registered on the course were telephoned or
visited in person the day before the course as a reminder. RESULTS: Registration
to attend the course was excellent. However, actual attendance rates were 58%
(42/72) out of those registered. Once participants attended, overall they enjoyed
attending the sessions and felt they benefited as they understood more about how
to better self-manage their condition. Those aspects of the sessions that were
most enjoyed were group discussions and interactive posters to explain diabetes.
Participants requested a home-based exercise guide, which was developed by the
research team. The study was underpowered to show behaviour change, but did
demonstrate a trend to improvement in self-care activities. All participants
reported recommending the course to others. CONCLUSIONS: There was an excellent response in terms of
registration for the course. However, the time to attend the course appeared to be a barrier to participants.
Nevertheless, for those
attending the course, responses were very positive. The amended X-PERT Programme could be used as a
component of a package to improve outcome and self-management for people with diabetes in the Bangladeshi
community.
J Immigr Minor Health. 2009 Feb;11(1):41-5.
The effectiveness of psychotherapy with refugees and
asylum seekers: preliminary results from an Austrian
study Renner W.
• Austria.
• An Austrian Non-Governmental Organization (NGO)
offered psychotherapy to 37 asylum seekers and
refugees (21 of them female) with a mean age of 36.1
years (s= 7.5), with the majority of them from Chechnya
or Afghanistan. Comparative data between the start of
therapy and the time of evaluation revealed a highly
significant positive effect (d = 0.77), while most therapies
were still going on.
• By a retrospective measure of perceived change, 85% of
the participants reported significant improvements. The
results show that even under difficult conditions, when
working with asylum seekers and refugees,
psychotherapy can be effective.
Health Serv Res. 2007 Apr;42(2):727-54.
Do professional interpreters improve clinical care for patients with limited
English proficiency? A systematic review of the literature.
Karliner LS, Jacobs EA, Chen AH, Mutha S.
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Division of General Internal Medicine, Medical Effectiveness Research Center for
Diverse Populations, Department of Medicine, University of California, San
Francisco, 1701 Divisadero, Suite 500, San Franicsco, CA 94143-1732, USA.
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OBJECTIVE: To determine if professional medical interpreters have a positive
impact on clinical care for limited English proficiency (LEP) patients. DATA
SOURCES: A systematic literature search, limited to the English language, in
PubMed and PsycINFO for publications between 1966 and September 2005, and a
search of the Cochrane Library. STUDY DESIGN: Any peer-reviewed article which
compared at least two language groups, and contained data about professional
medical interpreters and addressed communication (errors and comprehension),
utilization, clinical outcomes, or satisfaction were included. Of 3,698
references, 28 were found by multiple reviewers to meet inclusion criteria and,
of these, 21 assessed professional interpreters separately from ad hoc
interpreters. Data were abstracted from each article by two reviewers. Data were
collected on the study design, size, comparison groups, analytic technique,
interpreter training, and method of determining the participants' need for an
interpreter. Each study was evaluated for the effect of interpreter use on four
clinical topics that were most likely to either impact or reflect disparities in
health and health care. PRINCIPAL FINDINGS: In all four areas examined, use of
professional interpreters is associated with improved clinical care more than is
use of ad hoc interpreters, and professional interpreters appear to raise the
quality of clinical care for LEP patients to approach or equal that for patients
without language barriers. CONCLUSIONS: Published studies report positive
benefits of professional interpreters on communication (errors and
comprehension), utilization, clinical outcomes and satisfaction with care.
PMID: 17362215 [PubMed - indexed for MEDLINE]