Study transforming diabetes care with culturally tailored support for African and Caribbean communities

A healthy eating and physical activity programme created with, and for, people of African and Caribbean heritage living with type 2 diabetes in London is now seeking volunteers to test its effectiveness around the UK.  

Individuals from South London who were part of the co-development of the culturally relevant programme are now encouraging others to take part. 

Sandra Tomlinson, age 62 from Peckham, became involved in HEAL-D after her husband, Kelvin, was diagnosed with type 2 diabetes. As the main cook in the household, Sandra sought information and guidance on how to support her husband to make diet and lifestyle changes, but struggled to find what she needed. 

She said: “After the diagnosis our lives changed overnight. I knew I had to help my husband, but I didn’t know how. Suddenly, the meals we’d always loved together felt like they were off-limits, and I felt lost trying to figure out what was best for him. I tried changing my shopping habits and adjusting our recipes, but there just wasn’t enough information for people like us—people who cook the foods we grew up with. That’s when I discovered the HEAL-D programme and realised we weren’t alone in this.”

After being invited to become one of the co-producers of the HEAL-D intervention, Sandra worked as part of a focus group along with other members of the African and Caribbean communities in South London and researchers led by Professor of Nutrition Science, Louise Goff, now of the University of Leicester. 

As a group they worked to develop culturally relevant diet and cooking suggestions and physical activity programmes for people with type 2 diabetes.

Professor Louise Goff, who joined the University of Leicester from King’s College London in April 2023, is an academic dietitian specialising in the role of diet and lifestyle in the prevention and management of type 2 diabetes. Louise has a particular interest in tackling health inequalities among minority ethnic groups.    

She said: “Tackling ethnic inequalities in type 2 diabetes is a global healthcare priority.

“In populations of Black African and Caribbean ethnicity, rates of type 2 diabetes are around two to four times higher than in populations of White European ethnicity, and it develops, on average, 15 years earlier.

“Often, type 2 diabetes management advice centres around foods that don’t reflect the diets of African and Caribbean communities, such as yam, fufu, and plantain. The existing programmes simply didn’t meet the needs of many of the people taking part.

“We wanted to develop a practical self-management programme that would be much more representative of people with African and Caribbean heritage.”

In the National Institute for Health and Care Research (NIHR) funded study carried out with Louise’s former colleagues at King’s College London from 2016 – 2022, the team worked closely with people with type 2 diabetes, faith and community leaders and healthcare professionals in Black African and Caribbean communities in London.

Sandra added: “Louise and her team came out to the community and asked real people real questions and got real answers. That’s why I’m proud to be part of HEAL-D.”

Despite significant differences in recipes and cooking between the African and Caribbean communities involved in the study, the group looked for foods they had in common to develop a new approach.

Contributors like Sandra called on family for support, even asking them to send cookery books she had grown up with.

She continued: “I’m traditional, very much so. But I have learned so much about diet from being part of HEAL-D. It’s really important to get everybody involved. It’s much easier to cook one pot rather than two – so for us it was about adapting what I’m cooking so it works for everyone at home.”

Annette Palmer, a participant in the HEAL-D program at Guy’s and St Thomas’, successfully reversed her diabetes by the program’s end. 

Annette, from London, said: “I was given the tools and the resources and the help to go on that journey. It’s a very well thought about, comprehensive, culturally tailored programme. I felt understood, I felt cared for.”

Professor Louise Goff, funded by the NIHR Leicester Biomedical Research Centre, added: “We’re really excited to be taking HEAL-D forward to a trial to evaluate its clinical and cost-effectiveness in Manchester, Birmingham and London.”

Those in the study group will take part in seven two-hour sessions taking place every two weeks, followed by an eighth session six months later. These sessions will take place in culturally familiar community spaces, like church halls or community centres. Each session will include information about diet and physical activity, with some including group physical activity sessions run by a qualified health professional. 

Professor Goff continued: “Our study will compare the benefits and the cost of the HEAL-D programme against current diabetes education programmes. If HEAL-D is shown to be beneficial and affordable for the NHS, we hope it will be made more widely available to black African and Caribbean people living with type 2 diabetes around the UK.”

The NIHR Leicester BRC is part of the NIHR and hosted by the University Hospitals of Leicester NHS Trust in partnership with the University of Leicester, Loughborough University and University Hospitals of Northamptonshire NHS Group.