Collaborative communitY-based education programme to reduce Inequalities in the uptake of diabetes screening among Minority Ethnic peopLe in WaLes: Phase I feasibility study (CYMELL)

Contact details

Dr Gargi Naha : gargi.naha@swansea.ac.uk

Chief investigator

Dr Rose Stewart, Clinical Psychologist, Betsi Cadwaladr University Health Board

Co-investigators / research team

Dr Ashra Khanom (Swansea University lead), Professor Rhiannon Tudor Edwards (Bangor University), Mrs Thanuja Hettiarachchi (PPIE), Dr Jenna Jones (Swansea University), Mrs Rizwana Nadeem (PPI), Dr Nicola O’Brien (Northumbria University), Professor David R Owens (Swansea University), Dr Alison Porter (Swansea University), Professor Sian Rees (Swansea University), Mrs Rafat Arshad-Roberts (Betsi Cadwalladr University Health Board), Dr Shadan Roghani (Neath Port Talbot CVS), Dr Llinos Haf Spencer (Bangor University), Dr Rebecca Louise Thomas (Swansea University), Professor Alan Watkins (Swansea University)

Type of study

Pilot community interventional


The number of people diagnosed with Type 2 diabetes is increasing worldwide. Unfortunately, people from ethnic minority backgrounds are at greater risk – up to five times more likely to develop diabetes than those who are ‘white’; they develop diabetes at a younger age, and they are more susceptible to developing long-term complications of diabetes. The long-term complications of diabetes are harmful, life limiting and costly to treat. To detect and treat these complications in early stages, the NHS has nine ways of testing and screening people with diabetes. People from ethnic minority backgrounds are especially unlikely to get these checks. So, finding new ways of increasing their access to these checks would enable the early treatment and detection of long-term complications, especially blindness, amputations and kidney disease.

In the proposed study, we aim to do two things:

  1. To co-design and pilot a community-based screening education program to be co-delivered by diabetes specialist nurses and community leaders and support workers, to improve diabetes health literacy and accessibility of screening among people from ethnic minority backgrounds. Thereby increasing the uptake of screening among underserved populations.
  2. To determine the feasibility of a stepped wedge cluster trial design and data collection methods, so that we can make a decision about whether to proceed to a full trial, which can answer questions about whether the intervention is effective for patients and worthwhile for the NHS.

We will define key elements of an effective community-based intervention to improve accessibility and understanding of diabetes checks or screening, identify important outcomes, and understand how the intervention ‘Diabetes follow-on checks awareness raising workshops’ (DF-CARW) can achieve those outcomes. In addition, short languageless animations known as GIFs (Graphics Interchange Format) will also be developed to support the delivery of DF-CARW. We will pilot the DF-CARW intervention and support materials across three study sites in Wales.

We will work with six GP surgeries across three study sites in Wales to deliver the intervention. We will use three methods of data collection – questionnaires, focus groups and group interviews. We will ask participants taking part in the DF-CARW to complete a questionnaire at two-time points and take part in focus groups. NHS staff along with community leaders and support workers will be invited to attend group interviews to understand their views about delivering the intervention. Finally, we will consider the design for a future economic evaluation for a full trial by examining the trial data and resource use.

How could this research potentially benefit patients?

We will provide evidence on how to improve the uptake of diabetes follow-on checks in a population group that traditionally receives sub-optimal care. Follow-on checks for diabetes-related eye, kidney disease, as well as foot complications, have been shown to reduce morbidity from diabetes. By detecting diabetes-related complications early, less treatment is required and can lead to reduced sight loss, amputations and the need for dialysis.

Public / patient involvement

We have involved people with diabetes from ethnic minority backgrounds and people with expertise in engaging with ethnic minority groups from the start of the project. They have helped us to design this proposal and will help us develop educational materials, design the DF-CARW, and publicise the potentially influential findings. We will involve community leaders from ethnic minority backgrounds in these tasks, especially in encouraging patients to attend the DF-CARW. 

This study will adhere to the principles outlined in the NHS UK policy framework for Health and Social Care Research. It will be conducted in compliance with the protocol, the Data Protection Act and other regulatory requirements as appropriate.


Health and Care Research Wales  

Total grant value

£ 229,998

Start date


End date


Further information (e.g. related web link)

To follow

Outputs generated (Reports / Publications)

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