Lifestyle factors in the development of diabetes among African immigrants in the UK: A systematic review Alloh T. Folashade Faculty of Health and Social Sciences, Bournemouth University (falloh@bournemouth.ac.uk) Introduction Electronic databases search; CINAHL, CINAHL Plus, Embase, Medline complete, Scopus, EBSCO Books, Science Direct, PubMed, and Cochrane Library via EBSCO. Records identified through database searching (n = 3,541) Additional records identified through other sources (n = 17) Records screened on basis of title and abstract (n = 1,030) Full-text articles assessed for eligibility (n = 197) Studies included in qualitative synthesis (n = 5) Mixed method study (n= 1) Records excluded (n = 2,528) Duplicate removed Records excluded (n= 833) Conference abstract Type 1 diabetes Editorials Full-text articles excluded, with reasons (n = 109) Not African migrants (54) Not diabetes (16) No lifestyle (3) Before 2006 (9) Total numbers of articles retrieved (n= 3,558) Method Search Findings Most studies recruit African Caribbean and/ or African American with almost none including African immigrants in their study. Very limited studies have been conducted exclusively among African immigrants, hence the limited articles retrieved in this review. Diabetes is a global issue of public health concern. Type 2 diabetes is estimated to be about 422 million people globally 1. In the UK, there are more than 4 million cases of diabetes . African immigrants are over five times more likely to develop type 2 diabetes 2 . There is poorer health outcomes among African immigrants with diabetes as compared to the general population 2. Review Findings Themes No of studies Diabetes Knowledge 5 Healthy lifestyle knowledge 4 Religion impact 6 Lived experience of illness 2 Cultural influence 5 Lifestyle changes 1 Dietary habit 4 Physical activity 3 Mental distress 1 Aim To understand the lifestyle factors that contribute to the management of diabetes among African immigrants in the UK. Objectives To Understand the views and perception of African immigrants on diabetes development and management To identify the lifestyle factors among African immigrants living with type 2 diabetes. To explore how the identified lifestyle factors contribute/ influence the prevention and management of type 2 diabetes among this population. Discussion Reported low knowledge of diabetes among participants in most of the studies reviewed Religion and Cultural factors were very important among the participants in the studies reviewed. Muslim participants were willing to fast by abstaining from food and drink even against doctors warning. Culturally, overweight is seen as a good thing and it is sometimes encouraged. Adoption of western diet means more refined sugary products, fast foods and junks meals. Low level of physical activity was noted as African immigrants only take mandatory physical activity seriously. Data Extraction Customised data extraction form used, developed from standard forms. Critical Appraisal Modified version of Long et al3 and CAPS4 critical appraisal tools was used to appraise each article.   Inclusion Criteria Online and Hard copy articles Primary and review research Peer reviewed Published between 2006-2016 English written Considers Type 2 diabetes in Africans Recruit African immigrants Considers at least one factor that contribute to health e.g Physical activity, Diet Primary research: Qualitative, quantitative and mixed method studies. Figure 1: Flow diagram showing literature search strategy Conclusion It was noted that religion and culture were important factors that influence other factors . While it is appreciated that this is a small data set for a systematic review, it does not take away from the importance of the findings of this review.   Exclusion Criteria Not peer reviewed Published before 2006 Other language outside English Considers other diseases outside diabetes. Recruit other ethnic group outside African immigrants Address specific aspect of health e.g Sexual health Reports, letters, Editorials, Conference papers, Abstracts, Systematic reviews. Recommendation There is need for intervention to meet the cultural needs of Africans living with diabetes in the UK. There is need for physician to take the cultural, religious and other factors noted in this review into consideration when recommending behavioural change to adopt healthy lifestyle among Africans living with diabetes. The need for further research in this area is paramount to fully identify the lifestyle factors and how they contribute to the management of diabetes. Fig 2: Conceptual framework from review findings Photo source : Transforming Health. Available from: http://www.transforminghealth.org/stories/2012/11/keys-to-a-healthy-diet-and-lifestyle.php Reference World Health Organisation. Global Report on Diabetes: 2016; 2016 [Available from: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf Diabetes United Kingdom. Fact and stats 2015 [Available from: https://www.diabetes.org.uk/Documents/Position%20statements/Diabetes%20UK%20Facts%20and%20Stats_Dec%202015.pdf Long AF, Godfrey M. An evaluation tool to assess the quality of qualitative research studies. International Journal of Social Research Methodology. 2004;7(2):181-96. Critical Appraisal Tools (CAPS). CASP Checklists [online] 2014 [cited 2016 16th June]. Available from: http://www.casp-uk.net/#!casp-tools-checklists/c18f8 Supervisors Prof Ann Hemingway Dr Angela Turner