Author Identifier
Date of Award
2026
Keywords
prediabetic state, self-management, emigrants and immigrants, culturally competent care, cultural safety, health equity, type 2 diabetes prevention, mixed methods research
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy
School
School of Nursing and Midwifery
First Supervisor
Lisa Whitehead 
0000-0002-6395-0279
Second Supervisor
Johnny Lo 0000-0003-1913-5354
Third Supervisor
Kirsten Coppell 0000-0003-0996-2874
Abstract
Introduction: The management of prediabetes is a critical and challenging topic in Australian and global contexts. Up to 70% of individuals living with prediabetes eventually progress to type 2 diabetes without intervention. Timely and effective lifestyle interventions can delay, prevent or reverse the progression of prediabetes.
Background: In Australia, little research has been conducted on effective strategies to manage prediabetes for migrant populations with culturally and linguistically diverse backgrounds. Compared to native-born residents, Chinese-speaking immigrants have an increased risk of type 2 diabetes. Despite the importance of early intervention and prevention, research has focused on type 2 diabetes management. Little research has been conducted to explore the self-management behaviours of immigrants living with prediabetes. This thesis aimed to develop a culturally grounded prediabetes self-management intervention protocol with Chinese-speaking immigrants living with prediabetes in Australia.
Methods: This thesis focuses on describing the development phase of a complex intervention that is guided by the Medical Research Council framework for developing and evaluating complex interventions and used a mixed methods evaluation design. The intervention was developed in two phases, comprising four steps. Phase I comprised an exploratory qualitative needs assessment, which was followed by a mixed methods evidence synthesis using a convergent integrated approach. A qualitative study explored the cultural needs of Chinese-speaking immigrants with prediabetes in community settings and the barriers to and facilitators of self management they experienced. Formative research evidence, including qualitative findings, evidence summaries and a prior scoping review, were integrated with external evidence to inform the development of the initial intervention components.
Phase II refined the intervention protocol using a convergent design. Feedback on the proposed intervention content, delivery format and outcome measures was collected in parallel from interview participants with prediabetes through a workshop discussion employing the nominal group technique and from a multidisciplinary expert panel via a two-round e-Delphi process. The results were integrated using the pillar integration process to finalise the intervention.
Results: This research project developed a population-specific understanding of prediabetes self management and identified culturally contextualised intervention knowledge. Insights were synthesised into five themes, covering social determinants and actionable risks, cultural anchors, matching interventions to risks, self-management skills for nutrition and physical activity, and need-responsive solutions. The thematic findings informed the development of initial intervention components, including group-based education, individual coaching, digital support, cultural considerations, outcome measures and blended delivery. Integrated findings from community participants and experts provided strong support for the proposed intervention in relation to acceptability, cultural appropriateness and perceived feasibility of implementation. An intervention-ready protocol for feasibility testing was finalised after minor refinements had been made to enhance skills-building, clarify stress management, improve access to measurement and expand feasibility indicators.
Conclusion: This study produced an evidence-informed, culturally grounded prediabetes self-management intervention protocol for Chinese-speaking immigrants in Australia. The intervention centres on culturally and linguistically appropriate support to enable self-empowerment for practical, everyday behaviour change, tailored to individual risk profiles and social determinants of health. As a development-stage output, the protocol still needs further feasibility testing but offers a pragmatic starting point for more culturally responsive care for adults living with prediabetes.
Access Note
Access to this thesis is embargoed until 10th April 2028
Recommended Citation
Zhang, M. (2026). The development of a culturally grounded intervention for prediabetes self-management among Chinese-speaking immigrants in Australia: A mixed-methods study. Edith Cowan University. https://doi.org/10.25958/vz3k-qk50
Comments
Author is also known as Lisa Zhang