Effectiveness of a diabetes education and counseling program for Turkish, Moroccan and Hindustani patients by bicultural educators embedded in a multidisciplinary setting.

The prevalence of type 2 diabetes (DM2) has increased significantly in the past
ten years. Compared to the indigenous Dutch population, diabetes is two to
five times more common in non-western ethnic minority groups. Most of the older
immigrants live in a relatively traditional manner and their proficiency in the
Dutch language is limited. As a result of communication problems Dutch
physicians experience more difficulty in delivery op optimal diabetes care to
patient of ethnic minority groups. A former study showed a poorer glyceamic
control in Turkish DM2 patients compared to their Dutch counterparts, although
a similar diabetes care was provided. DM2 is a complex disease and treatment
usually demands for behavioural changes, and can only succeed in well
cooperative patients. Therefore a good understanding of the illness by the
patient is essential. Furthermore advices as well as behavioural rules should
be in line with the culture and social environment of the patients. We expect
that a cultural competent education (education in the native language with
respect to the patients* culture) can improve the diabetes care to DM2 patients
from non-western ethnic minority groups, and by that improve the patients*
compliance and the glycaemic control.

The main question is: does an ethnic specific cultural approach, including an
ethnic specific education programme and individual guidance by a bicultural
educator as part of the multidisciplinary team, has a beneficial effect on
glycaemic control in Turkish Moroccan and Hindustani type 2 diabetes patients

Secondary the effect on weight, diabetes related knowledge, quality of life,
determinants of behavioural change attitude, self efficacy, compliance towards
behavioural advices, and medication will be assessed.

waiting list controlled design. After informed consent the patients are
randomly assigned to either the intervention group or the waiting list
(control) group. All patients will receive usual care.

Patients from the intervention group receive six educational group sessions
given by bicultural health educators. The health educators will make use of a
diabetes education manual developed by the public health service Rotterdam for
the education of Turkish type 2 diabetes patients. Apart from the group
education, the health educators will counsel the diabetes patients during the
course of the study.

All patients are interviewed before and after the study. This will take about
for hours of the patients* time. The frequency of taking a venous blood sample
and of the physical examinations is once every 3 three months and does not
differ from the frequency in usual care, althoug the investigator will see to
more carefully that the examinations will take place.
The burden for patients from the intervention will be approximately 15 hours of
extra education and time for counseling.

In our opinion participation to this study will not create an extra risk for
the patients