This case study chapter presents the lived experiences of (n=30) British African-Caribbean women (18–75 years), who engaged with a culturally tailored and community-based diabetes risk awareness and prevention programme. The programme is appraised via focus groups with these women. By listening to the voices of these women, this case study chapter shows that health services have largely treated these British African-Caribbean women as ‘hard to reach’. However, these women do not categorise themselves as ‘hard to reach’, but rather argue that health services “are not reaching” them, by assuming that health practices are equally applicable and effective for all women.

It is argued that the design and delivery of previous services fail to recognise how intersections of these women's identities impact on their health and access to services. Recommendations are given to improve the development of health interventions by involving British African-Caribbean women in the design and provision of culturally tailored interventions in their communities and by applying intersectionality theory and methodological frameworks.

Introduction and background

Type 2 diabetes

Type 2 diabetes mellitus (T2DM) is one of the most common chronic illnesses in the United Kingdom (UK) (Diabetes UK, 2010, 2018). Some 3.8 million people are estimated to have both types of diabetes, but approximately 90% of diabetes cases are T2DM (Diabetes UK, 2010, 2018; Public Health England, 2016). It is a long-term condition that causes the level of sugar (glucose) in the blood to become too high due to the body not making enough insulin, or the insulin it is making is not being used properly (Diabetes UK, 2018). In total, it is estimated that 10% of the National Health Service (NHS) budget is spent each year on treating diabetes and its complications (Hex et al, 2012).

The central causes for this condition are being overweight and inactive and/or having a family history of the disease (Diabetes UK, 2010, 2018). The risk of developing T2DM can be reduced by changes in lifestyle and health-related behaviours, such as diet and physical activity (Sargeant et al, 2018). Early diagnosis and careful management are vital, to prevent the condition and associated complications such as heart attack, stroke and kidney disease.

Risk and prevalence of Type 2 diabetes in BME groups