Intended for healthcare professionals


Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives

BMJ 2008; 337 doi: (Published 04 November 2008) Cite this as: BMJ 2008;337:a1931
  1. Clare Grace, research dietitian1,
  2. Reha Begum, public health strategist2,
  3. Syed Subhani, bilingual health advocate3,
  4. Peter Kopelman, principal4,
  5. Trisha Greenhalgh, professor of primary health care5
  1. 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AT
  2. 2Public Health, Health Improvement Department, Tower Hamlets Primary Care Trust
  3. 3Health Advocacy Department, Tower Hamlets Primary Care Trust
  4. 4St George’s, University of London
  5. 5Department of Primary Care and Population Sciences, University of London
  1. Correspondence to: C Grace c.m.grace{at}
  • Accepted 22 August 2008


Objective To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community.

Design Qualitative study (focus groups and semistructured interviews).

Setting Tower Hamlets, a socioeconomically deprived London borough, United Kingdom.

Participants Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3).

Methods 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis.

Results Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding.

Conclusion Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.


  • CG was funded to undertake this research through a project grant from Diabetes UK. We thank the participants who gave generously of their time; Farah Suraiya, Mohammed Lais, and Tasnuba Subhani for their translation services; and members of the project advisory group.

  • Contributors: CG, TG, and PK designed the study. CG, SS, and RB recruited and ran the focus groups. CG and TG analysed and interpreted findings and wrote the paper. PK, RB, and SS provided feedback on earlier drafts. CG,PK, and TG are guarantors for the study.

  • Funding: This work was supported by Diabetes UK grant number BDA:RD04/0002780.

  • Competing interests: None declared.

  • Ethical approval: East London and City research ethics committee.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

View Full Text