The analysis will be based on studies carried out in the UK, USA, Australia, Europe and Canada. These geographical locations have been selected because of similarities in healthcare systems, and lifestyles.
The primary studies to be selected in the final synthesis will explore the effectiveness of nutritional interventions in reducing type 2 diabetes among BAME people.
Only studies published in English will be included
Studies carried out between 2010 and 2017 will be included in the final selection. This is to accommodate most current research evidence for evidence based practice.
High Prevalence of Type 2 Diabetes Mellitus with BAME People
There is a high prevalence of type 2diabetes mellitus with BAME people in the UK, and globally (Harrison, 2014; Public Health England, 2016). In agreement, Gatineau and Mathrani,( 2011) argue that BAME people have a high risk of developing T2DM which leads to physical health complications such as peripheral neuropath, limb amputations due to infected diabetic foot ulcers, blindness, renal failure as well as other cardiovascular complications associated with obesity and T2DM. Consequently, people die unnecessarily from a complication which can effectively be managed by diet and other lifestyle interventions (Boyington et al., 2009; Gatineau and Mathrani, 2011; Harrison, 2014). People from South Asian community have a six times risk of developing T2DM that any other ethnic group in the UK (Harrison, 2014). Black people (Africans and African Caribbean) have a three-times risk of developing type 2 diabetes mellitus (Harrison, 2014; Public Health England, 2015). In addition to causing serious morbidities, T2M costs the UK government almost £4 billion per year in treating complications associated with the condition (the National Audit Office, 2012).
Most of the high cases of T2DM in BAME people is attributable to diet such as foods saturated in fats, starchy foods, a high diet of carbohydrates (rice, chapatti, yams), butter, ghee, palm oil, maize meal, bread, and cassava (Hannif, 2015; Khunti, Kumar and Brodie 2009). Many studies have also highlighted cooking habits such as favouring a diet of deep fried foods (meat) and overcooking vegetables (destroying nutrients in so doing) as some of the causes of obesity and type 2 diabetes mellitus among most BAME people (Khunti, Kumar and Brodie 2009). In addition, most BAME people tend to eat big meals before bed-time, which results in unused energy being stored in the body as fats (Hanif et al., 2015). Vlaar et al., (2017) argue that lifestyle interventions which target some of these unhealthy behaviours such as physical exercising and eating healthy foods can be effective in reducing diabetes and/or reducing onset of T2DM in people at risk of developing the illness. For example, Vlaar et al., (2017) carried out a randomised controlled trial with 642 participants from South Asian Surinamese community in the Hague to investigate the effectiveness of these lifestyle (exercising and nutrition) on these communities which were at risk of T2DM. 332 participants who were at risk of developing T2DM were randomly assigned to receive motivational interviewing and supervised nutritional intervention and physical exercising. The control group (n-310) who had similar risk of T2DM were given generic advise by Dieticians on healthy eating. The study showed that participants in the intervention group managed to reduce risk of T2DM compared to those who received generic advice in the control group (Vlaar et al., 2017). The findings from this study indicated that through diet, people from BAME community can reduce their risk of developing T2DM, while these already diagnosed with the disease can control their blood glycaemia through diet.
Factors Contributing to High Incidences of T2DM in BAME People
However, there are other factors such as genetic factors, poverty, healthy literacy and cultural practices and beliefs which cannot be ignored, and which can contribute to high incidents of T2DM in BAME people. For example, most interventions which promote healthy eating encourage people to eat five portions of fruit and vegetables every day (Harrison, 2014). Without addressing poverty, these may not be affordable to most BAME people, especially those that live in deprived parts of the country, for example, in Coventry, many BAME people live in poor areas such as Longford, Hillfields, Stoke, Henley Green, Wood End and Foleshill(Coventry City Council, 2017) where most of the BAME people live.
Due to limitations in time and resources, the study will be literature based, whereby the author will identify relevant studies from research databases and synthesize the evidence before making conclusions on whether nutritional interventions are effective in reducing type 2 diabetes in ethnic minorities. A literature review is a comprehensive analysis of existing literature of studies carried out on a particular area under investigation (Taylor, 2006). As a result, a literature review is not an annotated bibliography. According to Bryman (2012), a literature review allows a researcher to identify, analyse, synthesise and summarise evidence on a particular phenomenon under investigation, before presenting it in a way which is logical.
Adam et al., (2007) maintain that there are many methods of conducting literature reviews, such as narrative or traditional literature reviews, narrative reviews, scoping reviews of systematic reviews. This dissertation will be conducted using a systematic review approach, which is a step-by-step approach of identifying and selecting relevant literature from research databases (Bryman, 2012). A systematic review approach uses the same rigours methods of identifying secondary sources in a way that eliminate researchers’ biases, for example, as in narrative reviews where the researchers can identify and select literature according to what they want to find (Bryman, 2012). A systematic review approach allows a researcher to create an inventory of how they search for literature and how they select relevant material. A Prisma’s flow chart (Prisma, 2009) which is a four stage process of identifying, screening, exclusion and selection of literature will be used to demonstrate how the author will select relevant studies for analysis. The advantages of literature reviews in general is that they allow novice researchers to analyse studies carried out by experienced researchers and research institutions which are well funded (Aveyard, 2010; Bryman, 2012). In addition, literature reviews save time and money as opposed to empirical studies (Aveyard, 2010). In addition, conducting a primary study would require the author to apply for ethical approval from the relevant research bodies such as the NHS Research Authority or the Coventry University before carrying out the primary study. This may be time consuming and frustrating (Bryman, 2012).The disadvantages of carrying out literature reviews are that the researchers will not report anynew findings, but will analyse and synthesise what has already been concluded by other researchers (Bryman, 2012). In addition, researchers who carry out literature reviews have no control over the quality of data collected by the primary researchers (Bryman, 2012;Creswell, 2013). Ideally, a preferred methodology for this kind of study would be a randomised controlled trial (RCT), to enable the researcher to randomly assign participants into two groups (Polit and Beck, 2014), where the control group will receive nutritional advice and monitoring, and the other group would receive treatment as usual such as Metformin and then compare the variables post-intervention.
1. Only randomised controlled trial studies would be included in the selection of studies.
According to Polit and Beck (2014), randomised controlled trials are
controlled and comparative experiments that are to investigate the effectiveness
of certain interventions, measured against control groups.
They are used in quantitative studies, and they enable researchers to
randomly assign people to different treatments and compare the variables.
RCTs, are ranked highly on the hierarchy of evidence (Polit and Beck, 2014)
, because researchers take precautions to reduce methodological
biases by using randomisation, and in some case,
blind randomisation (Polit and Beck, 2014). As a result, Polit and Beck (2014)
describe RCTs as belonging to a gold standard class.
The author will therefore only use RCTs for quantitative synthesis.
2. Only primary studies will be reviewed.
3.The analysis will be based on studies carried out in the UK, USA, Australia, Europe
and Canada. These geographical locations have been selected because of similarities in
healthcare systems, and lifestyles.
4. The primary studies to be selected in the final synthesis will explore the
effectiveness of nutritional interventions in reducing type 2 diabetes among BAME people.
5. Only studies published in English will be included
6. Studies carried out between 2010 and 2017 will be included in the final selection.
This is to accommodate most current research evidence for evidence based practice.
7. Studies that are peer reviewed will be included in the final synthesis.
8. Studies that are published in reputable journals will be included.
9. The Impact Factor of the journals will be taken into consideration.
According to Thomson Reuters (2010), the Impact factor of journals is the frequency with which
the journal is cited in other studies. However, Oermann et al. (2012) and Owlia et al. (2011)
argue that the IF of studies should not be viewed as an indicator of quality because
not all journals are indexed for the generation of Impact Factor.
10. Studies with full text will be included to allow the author a comprehensive analysis of
1. Qualitative studies will be excluded. According to Braun and Clarke (2006), most qualitative studies are subjective in nature because of the methodological flaws which enable researchers’ biases to influence the way the researchers ask questions or identify themes, which largely depend on interpreting social phenomenon according to how the researchers make sense of the data.
2. Studies published before 2010willbe excluded.
3. Studies focusing on other ethnic groups other than BAME people will be excluded.
4. Studies carried out in developing countries such as in Africa and India will be excluded because of differences in health care systems, availability of resources and different lifestyles.
5. Non-academic resources will be excluded to reduce bias.
6. Systematic reviews will be excluded from the final synthesis because they are views of other secondary researchers.
7. Studies without full text will not be included in the review
Chosen Methodology: Literature-Based Systematic Review
The overall framework is a literature review based on only quantitative, randomised controlled trial studies. As argued earlier, quantitative studies are ranked highly on the hierarchy of evidence whereas most qualitative studies are subjective in nature and ranked very low on the hierarchy of evidence (Polit and Beck, 2014). In all, the author will seek to review at least 15 primary studies for a comprehensive analysis of the role played by nutritional interventions in reducing or preventing type 2 diabetes mellitus. Quantitative studies belong to a positivist research methodology where researchers make sense of the world by analysing facts (Dyson and Norrie, 2013).
Method – specific techniques used in the execution of the study
According to Polit and Beck (2014), researchers can utilise various research models to break down their research topic as well as to identify search terms to use on research databases to identify literature. These models include the Client, Location, Improvement and Professional (CLIP) tool (Wong et al., 2013), the Setting, Perspective, Intervention, Comparison and Evaluation(SPICE) tool (Booth, 2006), the Population, Intervention Control and Outcome (PICO) tool (Bettany-Saltikov, 2016); or the Population, Exposure and Outcomes (PEO) tools (Bettany-Saltikov, 2016). For the purpose of this dissertation, the PICO tool will be used. The population will refer to Black, Asian and minority ethnic groups such as South Asians (Indians, Pakistanis and Bangladeshis), Africans, and African-Caribbean people in the UK, who are at high risk of developing type 2 diabetes mellitus as indicated earlier. The Intervention is diet or nutritional interventions, whereas the control will be RCTs which compare nutritional interventions with other interventions to reduce T2DM in the same population. Lastly, the outcomes are the findings from the studies.
Key search terms nutrition*OR nutritional interventions* OR diet* OR Lifestyle interventions* AND effectiveness* OR intervention*AND type 2 diabetes* OR diabetes* or gestational diabetes* AND Black, Asian, and ethnic minorities* OR ethnic minorities* will be used on research databases PubMed, British Nursing Database(BND), Medline and CINAHL to identify relevant studies. These databases will be used because they contain most current and relevant information in health and social studies (Parahoo, 2016). To remain focused, the author will use the inclusion and exclusion criteria discussed above.
The Holland and Rees (2010) critiquing framework will be used to critically analyse the strengths and weaknesses of each study. According to Holland and Rees (2010), secondary reviewers should critically analyse the robustness of methods used, which include a declaration of the researchers’ interest in the study, background to the study, research design and its appropriateness to the study, recruitment and selection of participants, data collection methods, data analysis methods, ethical issues, as well as overall strengths and weaknesses of the study in relation to findings. The author notes that there are many critiquing tools which include the Critical Appraisal Skills Programme (CASP) and the Polit and Beck ((2014) critiquing tool, and each tool has its own strengths and weaknesses.
Finally, the selection of studies will follow Prisma’s flow chart (identification, screening, eligibility and inclusion).
Because this is a literature review, data will be analysed according to how the findings are reported by the original researchers, and presented in statistical data since the primary studies are quantitative studies.
There presentation above shows bar form of data collected on control of diabetes type two in nutrition way: The variation of entities entails the nutrient diet Undertaken for purpose of controlling diabetes. Many people although we oversee the diabetic patients Take more of calories and fat food we need to counsel Them on how to manage such condition whenever they arise.
Advantages and Disadvantages of Literature Reviews
Tabular forms will be used to analyse the variation of population affected with type two diabetis using the fishers et al formular to came up with a sample size of the aged population with the blacks ,Asians and other ethical groups.
frequently in children and young people. Type 2 diabetes is often undiagnosed and studies to assess the number of newly occurring cases are complicated and consequently there are almost no data on true incidence.In high-income countries the prevalence of type 2 diabetes is frequently highest among people who are poor (10). There are few data on the income gradient of diabetes in low- and middle-income countries, but data that exist suggest that although the prevalence of diabetes is often highest among wealthy people, this trend is reversing in some middle-income countries (10).The proportion of undiagnosed type 2 diabetes varies widely – a recent review of data from seven countries found that between 24%
BELOW ARETRENDS IN PREVALENCE OF DIABETES, 1980–2014, BY WHO REGION
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Region of World
Dietary control of diabetes coverage response in United Kingdom as highlighted in the chart above shows many have been encouraged on nutritional method than dependant on pills this is according to WHO 2014 . This is as shown in the table below
Supervisor cold be anyone interested in type 2 diabetes and management, or nutrition and physical health
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