Minority ethnic groups often experience higher morbidity and mortality than majority populations for a range of chronic diseases.1 For example, compared with the majority white population, people of South Asian origin in the UK have a higher prevalence of diabetes,2 are almost twice as likely to die from cardiovascular disease,3 and have three times the hospital admission rate for asthma.4 Ethnic diversity is increasing in most industrialised countries. The need to reduce inequalities in health outcomes between majority and minority groups is widely recognised by governments5 and physician groups.6 Education programmes that promote self-management of chronic disease can reduce morbidity.7,8
Increasing ethnic diversity of populations means that the development and evaluation of cultural adaptations of such programmes are a priority. Minority ethnic groups are often under-represented in trials of self-management programmes9 and culturally adapted self-management programmes are rare. Trials of self-management education in populations of ethnic diversity suggest that minority groups derive less benefit than majority groups.10,11 Promoting partnerships between empowered or ‘expert’ patients and physicians is seen as a fundamental part of modern chronic disease management.12 Minority ethnic groups may have difficulty establishing such partnerships.13 Lay, or peer-led educational programmes, notably the Chronic Disease Self-management Programme (CDSMP),14 aim to promote patient expertise and are becoming an established part of chronic disease management in the US, Australia and the UK, the latter as the UK Expert Patient Programme.15 Culturally-adapted versions of lay-led programmes have the potential to overcome cultural and language barriers that may limit the effectiveness of professionally-led educational programmes, but have been tested only in Hispanic minority groups.16,17
How this fits in
Reducing the impact of chronic disease in minority ethnic groups is an important public health challenge. Culturally adapted, lay-led health education may overcome barriers that limit the effectiveness of professionally-led programmes. The impact of the CDSMP (Expert Patient Programme) in the UK is unknown. A culturally-adapted, lay-led self-management education programme improves self-efficacy, self-care behaviour and health status in Bangladeshis with chronic disease. Benefits were limited by moderate uptake and attendance. Effects on healthcare use and physiological and metabolic markers of disease control are unclear.
The Bangladeshi community in the UK are a marginalised ethnic group. They experience marked socioeconomic deprivation, have poor access to care and services and report the highest levels of chronic disease of any ethnic group in the UK.18,19 We tested the hypothesis that a culturally-adapted version of the CDSMP (the Expert Patient Programme) would improve the health of Bangladeshi patients with diabetes, heart disease, respiratory disease or arthritis, living in Tower Hamlets, east London. We report the first randomised trial to test the benefit of any self-management education programme for any South Asian group and the first randomised trial to test the effectiveness of the CDSMP in Europe.
