Exploring Factors Impacting the Self-Management of Type 2 Diabetes in Older Black African and Afro-Caribbean People (BAACP): A Qualitative Evidence Synthesis

PURPOSE: The purpose of this qualitative evidence synthesis (QES) was to synthesize qualitative evidence on perceived barriers and facilitators influencing self-management of type 2 diabetes mellitus (T2DM) among older Black African and Afro-Caribbean adults. METHODS: A QES of qualitative and mixed-methods studies with extractable qualitative findings was conducted using the PICO (Population, Phenomena of Interest, Context) framework and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Searches were undertaken in MEDLINE, PubMed, CINAHL, PsycINFO, African Journals Online, and Worldviews on Evidence-Based Nursing for studies published between January 2010 and June 2025. Studies were screened against predefined eligibility criteria. Methodological quality was assessed using the Critical Appraisal Skills Program checklist, and findings were synthesized thematically. RESULTS: From 5092 records, 12 studies met the inclusion criteria. Five overarching themes were identified. Key facilitators included spirituality, culturally responsive health care, and strong family or community support networks. Major barriers included limited health literacy, mistrust of health care systems, cultural conflicts with biomedical advice, and structural barriers such as financial constraints, limited access to health care services, and racial discrimination. CONCLUSION: Self-management of T2DM in older Black African and Afro-Caribbean adults is shaped by interconnected cultural, relational, and structural influences. Diabetes services should prioritize culturally tailored education, trust-building clinical relationships, family and community-engaged interventions, and addressing social determinants and racial inequalities to improve self-management outcomes in this population.