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Investigating the impact of Community Champions for promoting the initiation of insulin therapy in patients with Type 2 Diabetes from ethnic minority populations


Department of Health Sciences

About the Project

Proposed start date: January 2021

Closing date for applications: 4th December 2020

Eligibility: UK/EU (must be based in the UK) applicants

Department/School: Health Sciences (Diabetes Centre of Research)

Supervisors: Dr Pratik Choudhary ()
Professor Kamlesh Khunti ()
Dr Patrick Highton ()

Project Description

Project aims: The aim of this project will be to investigate the impact of using Community Champions to support insulin initiation in patients with T2DM from ethnic minority populations, via the following objectives:

1. Explore the literature to investigate the role of Community Champions in the promotion of health in ethnic minority populations

2. Identify and adapt pre-existing resources relevant to the area of insulin initiation or treatment within UK ethnic minority populations

3. Use these identified research gaps, pre-existing resources and community engagement and involvement to develop an intervention designed to improve insulin initiation in ethnic minority populations within the UK, with the support from Community Champions

4. Pilot test the developed intervention

Methodology

This PhD project will employ a mixed-methods approach – the post holder will undertake literature reviews, focus groups/discussions and interviews with community members and/or healthcare professionals and complete patient recruitment and data collection with the support from supervisors. The successful applicant will be embedded with a team of experts in diabetes and ethnic minority health and receive training and support in a wide variety of research methodologies. The PhD project will be integrated into a vibrant postgraduate research community within the Diabetes Research Centre and the Centre for Black, Minority and Ethnic Health at the University of Leicester, and help advance the aims of the Applied Research Collaboration (ARC) East Midlands and the National Institute of Health Research Leicester Biomedical Research Centre (BRC).

Year 1: Systematic review of the literature and focus groups validating barriers and discussing experiences within:
• Individuals from ethnic minority populations who have Type 2 Diabetes and have started insulin
• Individuals from ethnic minority populations who have Type 2 Diabetes and declined insulin therapy
• Healthcare practitioners (doctors and nurses) from both primary and secondary care

Year 2: Develop training for community champions based on the literature review and the findings of the focus groups

Year 3: Run 3-5 pilot sessions and collect user feedback

Background

Many patients who are diagnosed with Type 2 Diabetes Mellitus (T2DM) do not achieve adequate glycaemic control using optimised doses of oral anti-hyperglycaemic medications, resulting in increased all-cause and cardiovascular mortality and reduced quality of life1. Injectable Insulin therapy is typically recommended in the case of poor glycaemic control following oral therapies2, however insulin initiation is often delayed. Evidence has shown that the HbA1c at which insulin is typically initiated in T2DM is >9% (75mmol/mol)3 in spite of treatment guidelines, and some patients remain on oral anti-hyperglycaemic medications for a mean duration of 7.7 years despite glycaemic control being poor4. This is often due to a variety of factors including misconceptions regarding risk, desire to focus on lifestyle changes, low self-efficacy, injection phobia, low health literacy, worries about impact on social life, limited insulin self-management support5 and clinical inertia6.

Ethnic minority populations are at significantly greater risk of delayed insulin initiation7. This may be due to a variety of factors specific to ethnic minority populations, including: increased likelihood of having negative attitudes towards insulin therapy8; language barriers and lower health literacy; social stigma or insulin therapy conflicting with religious beliefs or practices (e.g. dietary fasting)9; increased time requirements of managing patients from ethnic minority populations due to language or literacy barriers, and increased concerns about negative observations from community networks10.

A potential avenue to address the problem of insulin initiation in ethnic minority populations is the use of peer support for patients10. Peer support is effective for improving knowledge, attitudes and beliefs towards health promotion and disease prevention11 and has been recommended in NICE guidelines for health promotion in ethnic minority populations12. The use of ‘Community Champions’, who engage people from ethnic minority groups and other socioeconomically deprived communities, has proven effective in fostering patient engagement13. Community Champions can help to educate patients with regards to what T2DM is, signs and symptoms, myths and misconceptions, complications and available services in a way that is culturally appropriate, directly from a member of that community14. However, the impact of using Community Champions to promote insulin initiation in patients with T2DM from ethnic minority communities has not yet been investigated, and represents an important avenue for research.

Entry requirements

Applicants are required to hold a UK Bachelor Degree 2:1 or better (or overseas equivalent) in a relevant health-related subject and a Master’s degree in a health-related subject.

The University of Leicester English language requirements apply where applicable: https://le.ac.uk/study/research-degrees/entry-reqs/eng-lang-reqs

Application advice

To apply, please submit an online application via: https://srs.le.ac.uk/sipr/sits.urd/run/siw_ipp_lgn.login?process=siw_ipp_app&code1=RHHC01FN&code2=0089

With your application, please include:
• CV
• Personal statement explaining your interest in the project, your experience and why we should consider you
• Degree Certificates and Transcripts of study already completed and if possible transcript to date of study currently being undertaken
• Evidence of English language proficiency if applicable
• In the reference section please enter the contact details of your two academic referees in the boxes provided or upload letters of reference if already available.

In the funding section please specify that you wish to be considered for the NIHR Applied Research Collaboration East Midlands studentship

In the proposal section please provide the name of the supervisors and project title (a proposal is not required)

Project / Funding Enquiries: Dr Pratik Choudhary

Application enquiries to

Funding Notes

This 3-year PhD studentship provides:
• UK/EU tuition fee waiver
• Annual stipend based on UKRI rates (£15,285 for 2020/21)
• Research Training Support Grant (including travel allowance)

References

1. De Vegt F, Dekker J, Ruhe H, et al. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study. Diabetologia. 1999;42(8):926-931.
2. Holman RR, Thorne KI, Farmer AJ, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. New England Journal of Medicine. 2007;357(17):1716-1730.
3. Blak B, Smith H, Hards M, Maguire A, Gimeno V. A retrospective database study of insulin initiation in patients with Type 2 diabetes in UK primary care. Diabetic Medicine. 2012;29(8):e191-e198.
4. Calvert MJ, McManus RJ, Freemantle N. Management of type 2 diabetes with multiple oral hypoglycaemic agents or insulin in primary care: retrospective cohort study. British Journal of General Practice. 2007;57(539):455-460.
5. Karter AJ, Subramanian U, Saha C, et al. Barriers to insulin initiation: the translating research into action for diabetes insulin starts project. Diabetes care. 2010;33(4):733-735.
6. Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes care. 2013;36(11):3411-3417.
7. Pilla SJ, Yeh H-C, Juraschek SP, Clark JM, Maruthur NM. Predictors of insulin initiation in patients with type 2 diabetes: an analysis of the look AHEAD randomized trial. Journal of general internal medicine. 2018;33(6):839-846.
8. Kunt T, Snoek F. Barriers to insulin initiation and intensification and how to overcome them. International Journal of Clinical Practice. 2009;63:6-10.
9. Visram H. Patient barriers to insulin use in multi-ethnic populations. Canadian journal of diabetes. 2013;37(3):202-204.
10. Patel N, Stone M, Chauhan A, Davies M, Khunti K. Insulin initiation and management in people with Type 2 diabetes in an ethnically diverse population: the healthcare provider perspective. Diabetic medicine. 2012;29(10):1311-1316.
11. Ramchand R, Ahluwalia SC, Xenakis L, Apaydin E, Raaen L, Grimm G. A systematic review of peer-supported interventions for health promotion and disease prevention. Preventive medicine. 2017;101:156-170.
12. NICE. Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups. 2018.
13. Katigbak C, Foley M, Robert L, Hutchinson MK. Experiences and lessons learned in using community‐based participatory research to recruit Asian American immigrant research participants. Journal of Nursing Scholarship. 2016;48(2):210-218.
14. Diabetes UK. Community Champions: What is the role of a Diabetes Community Champion? https://www.diabetes.org.uk/get_involved/volunteer/community-champions. Published 2020. Accessed.

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