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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.
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.

Adaptation and evaluation of a digital dialectical behaviour therapy for youth at clinical high risk for psychosis: A protocol for a feasibility randomized controlled trial

by Thea Lynne Hedemann, Yun Lu, Sofia Campitelli, Lisa D. Hawke, Nelson Shen, Sarah Saperia, Brett D. M. Jones, Gillian Strudwick, Chelsey R. Wilks, Wei Wang, Marco Solmi, Michael Grossman, Muhammad Ishrat Husain, Nicole Kozloff, George Foussias, Muhammad Omair Husain

Background

Youth at clinical high risk (CHR) for psychosis often experience emotional dysregulation, psychiatric symptoms, substance use, suicidality, and functional impairment. Dialectical behaviour therapy (DBT) is an evidence-based intervention that improves emotion regulation, clinical outcomes, and functioning across psychiatric populations. Digital adaptations (d-DBT) may enhance accessibility and engagement for CHR youth, but acceptability and potential benefits in this group are unknown.

Objective

To adapt d-DBT for CHR youth and evaluate the acceptability of delivering it to this population, as well as the feasibility of a larger-scale clinical trial.

Methods

This mixed-methods clinical trial has two phases. In Phase 1, d-DBT will be adapted for CHR youth in collaboration with a lived-experience youth advisory group. In Phase 2, an assessor-masked randomized controlled trial will compare d-DBT (n = 30) with treatment as usual (n = 30). The intervention consists of eight weekly modules, with primary outcomes assessing acceptability, usability, and trial feasibility. Secondary outcomes include changes in emotional dysregulation, psychiatric symptoms, substance use, suicidality, and functioning.

Conclusions

We anticipate that d-DBT will be acceptable to CHR youth and that conducting a larger trial will be feasible. Preliminary findings may demonstrate improvements in emotion regulation, psychiatric symptoms, suicidality, and functioning. Results will guide further refinement of the intervention and inform the design of a confirmatory clinical trial.

Trial registration

ClinicalTrials.gov #NCT06928935

Positive health programme for British South Asian women with postnatal depression: a multiperspective qualitative study

Por: Miah · J. · Bee · P. E. · Lunat · F. · McPhillips · R. · Taylor · A. K. · Aseem · S. · Sharma · D. · Husain · N. · Chew-Graham · C.
Objectives

To explore the views and perspectives of British South Asian (BSA) women and Positive Health Programme (PHP) facilitators on the usefulness and experiences of the PHP intervention for managing postnatal depression (PND) in primary care settings.

Design

Qualitative study with semi-structured interviews to explore perceptions of acceptability and implementation. A patient and public involvement group provided their insights and feedback on study topic guides, analysis and outcomes.

Setting and participants

We sampled trial participants from the PHP intervention database to ensure variation in geographic setting, age, socioeconomic status and ethnicity. PHP facilitators involved in the trial were also invited to participate in an interview.

Interviews with study participants were conducted at participants’ homes, and community centres, or via phone. Interviews with PHP facilitators were conducted via phone or online. Interview recordings were transcribed verbatim and analysed using thematic analysis and subsequently the Theoretical Framework of Acceptability (TFA) was applied. Recruitment took place between February 2017 and March 2020.

Results

Thirty interviews were conducted—19 trial participants and 11 PHP facilitators. The PHP intervention was viewed positively, with appreciation of its therapeutic content and components such as childcare and refreshments that facilitated engagement. Participants reported improved confidence and well-being and supported their needs. Participants understood the intervention’s purpose. Both intervention participants and facilitators noted strengthened self-efficacy.

Some participants experienced difficulties balancing childcare and attendance, implying a need for logistical assistance. Stigma about mental health in the BSA community was viewed as persistent, recommending future programmes efforts on strategies to reduce stigma and develop supportive environment.

Conclusion

This study demonstrates the possibility of PHP intervention being integrated into routine care by providing culturally tailored support for BSA women with PND, primarily through family engagement and facilitator support. Future research on scalability, alongside community engagement efforts, will strengthen its acceptability and broader applicability.

Trial registration number

ISRCTN10697380.

Understanding Canadian experiences of suicidality during the COVID-19 pandemic: protocol of a pan-Canadian qualitative study

Por: Baharikhoob · P. · Hollenberg · E. · Cuperfain · A. B. · Rudoler · D. · Nicoll · G. · Blumberger · D. · Bolton · J. · Chartier · G. B. · Crawford · A. · Furqan · Z. · Gajaria · A. · Gratzer · D. · Hatcher · S. · Husain · M. I. · Kurdyak · P. · Lam · J. S. H. · Lavergne · M. R. · Marshall
Introduction

The COVID-19 pandemic led to major disruptions in society across many spheres, including healthcare, the economy and social behaviours. While early predictions warned of an increased risk of suicide during and after the COVID-19 pandemic, rates of suicide deaths remained stable or decreased over that period for most countries. In contrast, the prevalence of suicidal ideation doubled and suicide attempts slightly increased during the COVID-19 pandemic in the adult general population worldwide, accompanied by a higher prevalence of major depressive disorder and anxiety disorders. While these data can tell us what happened, they cannot tell us why. Qualitative suicide research seeks to understand experiences of individuals with suicide-related thoughts and behaviours, provides an in-depth exploration of their lives and interactions with others and centres their views and unique context. There is little qualitative research focusing on suicidality during the pandemic. This study will use a qualitative approach to explore the extent and impact of the COVID-19 pandemic on Canadians who experienced suicidality and review their experiences of accessing mental healthcare to identify key components in supporting safety and recovery.

Methods and analysis

This study will involve approximately 100 semistructured interviews with participants across four Canadian provinces and will explore experiences with suicide-related thoughts and behaviours during the COVID-19 pandemic. Transcripts will be analysed through qualitative analysis informed by constructivist grounded theory.

Ethics and dissemination

The study was approved by the Research Ethics Board of the Centre for Addiction and Mental Health, Toronto Academic Health Sciences Network (for JZ: CAMH REB No 104-2022). In addition to traditional peer-reviewed presentations and publications, a report will make study findings accessible to policy makers, media and the public.

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