Diabetes knowledge, risk and severity perceptions, lifestyle behaviours and management barriers among Sub-Saharan African immigrants living in the UK: an ethnographic study

Abstract
Background: Type 2 diabetes shows greater incidence among ethnic minority groups than their indigenous counterparts, including Sub-Saharan African migrants in the UK. Little is known about their perceived knowledge of diabetes risks, severity and barriers, and the impact on their behaviours. Knowledge of their diabetes health is viewed through studies of other ethnic minority groups, making it difficult to differentiate findings relevant to Sub Saharan Africans and the associated impact of their unique sociocultural contexts. This study sought to bridge this knowledge gap.
Methods: Data for this ethnographic study was generated from eleven participants through in-depth observations, conversational interviews, field/reflective notes during food purchasing, meal preparation and consumption over a period of six months in Southeast London. Data was analysed using thematic analysis.
Results: Participants expressed extensive encounters and experiences with diabetes, yet, they had poor diabetes knowledge and perceptions regarding its risks and severity with many perceived barriers. Diabetes was perceived not to be serious as HIV/Aids, cancer, painful and infectious diseases, thereby given limited attention. Participants saw their cultural foods as nutritious, healthy and of good quality and were preferred over other diets, although their cultural foods were carbohydrate rich and mainly sold in processed forms. Participants complained of limited availability of fresh cultural produce and dislike for alternatives due to unfamiliar looks, textures and tastes. Culturally, Bulky weight was preferred over slimness. Slim individuals were stigmatised. Poor association of physical activity with diabetes management, time, motivation, limited support, laziness and tiredness hindered engaging in exercise. Difficulty navigating the healthcare system, time and costs prevented use of healthcare services.
Conclusion: Culturally structured and targeted interventions to raise diabetes knowledge, risks and severity perceptions and the benefits of effective management of type 2 diabetes will decrease perceived barriers to achieve desired outcomes. There should be ongoing education in communities, associations, and churches to raise diabetes awareness to modify their lifestyles. ‘Health-matching’, where patients are seen by providers conversant with their cultural beliefs and practices, should be considered by primary healthcare providers. Increased imported foods from Sub-Saharan African countries should be encouraged by food importers.