Maintaining cultural identity : A systematic mixed studies review of cultural influences on the self-care of african immigrants living with non-communicable disease

Aim
To understand and identify cultural factors influencing the self-care practices of African immigrants living with chronic illness in countries outside Africa.

Background
The influence of cultural factors on self-care is relatively unexplored in African immigrants with non-communicable diseases (NCDs).

Design
Systematic Mixed Studies review.

Data sources
PubMed, Psych Info, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus and Sociological Abstract computerized databases. No limit was placed on publication date.

Review methods
Results-based convergent design was used. The Mixed Method Appraisal Tool was used to evaluate the studies. Quantitative studies were synthesized narratively while qualitative studies were synthesized using thematic synthesis.

Results
We identified 251 articles and nine fulfilled our inclusion criteria. The studies were published between 2006 and 2019, with six qualitative and three quantitative studies. Studies were conducted in the United States, Australia, Sweden, the Netherlands and the United Kingdom. Most studies examined the influence of culture on self-care of diabetes (n = 6), while the rest focused on hypertension (n = 3). Findings highlight that cultural norms and practices, non-Western approaches to interpreting and managing illness, cultural connotations of health behaviours and structural challenges influencing self-care. Cultural food preferences made adherence to prescribed diets challenging. Family support facilitated self-care. Maintaining cultural identity was both a driver and constraint to engaging in self-care.

Conclusion
The complex interplay of cultural and structural factors influences the willingness of Africans who have immigrated to a developed country to follow recommended self-care practices. Considering these cultural norms and structural barriers can help to explain the self-care behaviours of African immigrant populations.

Impact
Clinicians and policymakers who account for structural factors and integrate cultural factors into care facilities, treatment protocols and policy can be influential in promoting self-care in African immigrant populations.