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☐ ☆ ✇ BMJ Open

Understanding barriers and facilitators to education and rehabilitation interventions for South Asian people with long-term conditions: a systematic review and meta-ethnography

Por: Shiel · E. V. · Miah · J. · Chattopadhyay · T. · Rauf · A. · Dalton · C. · Husain · N. · Blakemore · A. — Enero 13th 2026 at 15:20
Objectives

South Asian populations in the UK experience increased health risks related to long-term conditions, exacerbated by underdiagnosis, cultural differences in help-seeking behaviours, language barriers, low health literacy and a lack of culturally sensitive services. We know that group interventions that include education and rehabilitation, such as cardiac and pulmonary rehabilitation, are highly effective, but people from diverse communities often face barriers to access and engage with them. This review aims to synthesise evidence on the barriers and facilitators to education and rehabilitation interventions experienced by South Asian people living with long-term conditions.

Design

A systematic review of qualitative studies using meta-ethnography as the analytical approach to synthesis was conducted, following Noblit and Hare’s approach, eMERGe Reporting Guidance for Meta-Ethnography, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were performed across MEDLINE, PsycINFO, CINAHL, CENTRAL, EMBASE and Applied Social Sciences Index and Abstracts from database inception through March 2024 (updated April 2025).

Data sources

MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost platform), CENTRAL (Cochrane Library), EMBASE (Ovid), Applied Social Sciences Index and Abstracts (ProQuest platform) were searched from inception to March 2024 (updated April 2025).

Eligibility criteria

We included qualitative research exploring the attitudes, views and experiences of South Asian adults (outside of South Asia) with diabetes, cardiovascular disease or chronic obstructive pulmonary disease (COPD) regarding group treatments for these conditions.

Data extraction and synthesis

Two independent reviewers searched, screened and coded studies, while remaining authors peer-reviewed. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data extraction and synthesis followed eMERGe and PRISMA reporting guidance, with findings synthesised qualitatively.

Results

Of 8348 identified citations, 17 studies met inclusion criteria, providing data from South Asian people living with cardiovascular disease and diabetes mellitus. No studies including people with COPD met the inclusion criteria. Synthesis revealed four overarching themes, each incorporating both barriers and facilitators: faith, culture, communication, and safe space and professional relationship.

Conclusions

Findings indicate that current group education and rehabilitation interventions are not fully inclusive of South Asian needs, often lacking cultural sensitivity, which impedes engagement. Special attention is required for South Asian women, who can face additional cultural and societal barriers. Addressing these challenges through culturally sensitive care, such as flexible intervention scheduling around religious practices, gender-sensitive adaptations and culturally tailored communication strategies, has potential to improve engagement in education and rehabilitation interventions, and therefore long-term condition outcomes.

PROSPERO registration number

CRD42024493644.

☐ ☆ ✇ BMJ Open

Prevalence of epilepsy and the epilepsy treatment gap in Bauchi, Northeast Nigeria: a cross-sectional study of two communities

Por: Nuhu · U. A. · Alkali · N. H. · Hassan · H. F. · Garba · M. · Abdulrauf · T. · Ibrahim · A. · Owolabi · L. · Ogunniyi · A. O. — Noviembre 30th 2025 at 04:37
Objective

Epilepsy prevalence varies widely across Nigeria, with rates ranging from 3.1 to 37.0/1000 population. There have been no studies on epilepsy prevalence and treatment gap in the Northeast Region of Nigeria. This study aimed to study epilepsy prevalence and the epilepsy treatment gap (ETG) in an urban and a rural community in Northeast Nigeria.

Design

Cross-sectional, community-based survey.

Setting

Epilepsy screening of residents in two communities in Northeast Nigeria using a WHO screening tool and a validated study questionnaire from 1 March to 10 June 2022.

Participants

8599 community residents aged ≥2 years.

Outcome measures

Prevalence of epilepsy, active epilepsy, ETG and associated factors.

Results

We screened 8599 residents, of whom 88 had epilepsy. Crude epilepsy prevalence was 10.2 per 1000 and was three times higher in the rural than in the urban community (18.5 vs 6.4; 2=26.79, p2=0.087, p=0.768). Logistic regression analysis showed that the ETG was associated with a lack of counselling (OR 15.8, 95% CI 3.5 to 70.7, p

Conclusion

The prevalence of epilepsy in Bauchi State was within the range reported in Nigeria but three times higher in the rural than in the urban community. A high ETG was associated with poor counselling of people with epilepsy. Epilepsy counselling, health education and wider access to neurology services could reduce the burden of epilepsy in Northeast Nigeria.

☐ ☆ ✇ BMJ Open

Development of intersectoral medical care for patients with 'chronic critical illness: protocol for a telemedicine interventional study with a pre-post design in out-of-hospital intensive care facilities (E=MC{superscript 2})

Por: Edel · A. · Jöbges · S. · Weiss · B. · Paul · N. · Lyall · M. L. · Hoffmann · C. · Schüürhuis · S. · Piper · S. K. K. · Konietschke · F. · Berger · E. · Busse · R. · Marschall · U. · Kraufmann · B. · Witzenrath · M. · Eckardt · K.-U. · Spies · C. — Septiembre 18th 2025 at 03:51
Introduction

Patients receiving long-term ventilation (LTV) in out-of-hospital intensive care facilities often suffer from persistent impairments of their cognition, mental health and physical health, limiting their social participation. Chronically ill patients are often unable to express their care preferences. Thus, their medical care often lacks integration of patients’ wishes and values. Telemedicine may be used to collect patient-reported outcome measures (PROMs) from these patients to align medical care with their preferences. Early integration of teleconsultation to provide rapid support for specific patient symptoms can reduce economic costs.

Method and analysis

This is a multicentre, prospective, non-blinded, single-arm interventional trial with a pre-post design and follows the Standard Protocol Items: Recommendations for Interventional Trials statement. 10 out-of-hospital intensive care facilities in Berlin and Brandenburg, Germany, are grouped into three clusters. The study population includes adult patients (≥18 years) receiving LTV and residing in participating care facilities. During the preintervention phase, standard patient care remains unchanged. From the start of the intervention phase, enrolled patients receive telemedicine rounds in addition to standard care. These telemedicine rounds, conducted at least weekly, involve on-site healthcare professionals, patients and their relatives. Data are collected at predefined time points—study months 1,3, 9, 15 and 21—with a target of 57 participants at each time point. The study aims to evaluate whether a structured telemedicine intervention (1) increases the proportion of patients receiving record-documented PROMs in routine care and (2) reduces hospital readmissions. Secondary outcomes include the evaluation of post-intensive care syndrome, healthcare costs and the usability, applicability and perceived benefits of telemedicine. Additionally, qualitative interviews with patients, their relatives and healthcare professionals will explore individual experiences with chronic critical illness, the perceived quality of life of the patients and how team members manage moral distress in caregiving contexts. A mixed-effects logistic regression model will be used to analyse patients’ access to PROMs, while a mixed-effects Poisson regression model will be employed to evaluate hospital readmission rates. The findings may provide valuable insights into how telemedicine can improve patient-centred care for this particular patient group.

Ethics and dissemination

This study protocol received approval from the Ethics Committee of Charité—Universitätsmedizin Berlin, Germany (EA2/136/22). The findings will be disseminated through publication in a peer-reviewed scientific journal and presented at international conferences.

Trial registration number

This study was registered in the ‘German Register of Clinical Studies’ (DRKS; DRKS00029326).

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