Appendix 1 Prisma Chart: Effectiveness of cultural competence interventions
Records identified through database searching
(n = 175 )
Records after duplicates removed
(n = 163 )
Records identified through Cochrane database searching
(n = 1)
Studies included in review
(n = 8)
Full-text articles assessed for eligibility (n=7)
Records excluded
(n = 138)
Records excluded (n =18)
Records screened title and abstract
(n = 25)
Records screened title
(n = 163)
Eligibility Screening
Appendix 2 Prisma Chart: Cultural similarity and workforce diversity
Records identified through database searching
(n = 798 )
Identification
Records after duplicates removed
(n = 782 )
Screening
Records excluded
(n = 748)
Records screened title
(n = 782)
Records excluded (n =20)
Records screened title and abstract
(n = 34)
Eligibility
Full-text articles assessed for eligibility (n=14)
Records excluded (n =3)
Records identified through reference lists and citations (n = 2)
Eligible articles
(n = 11)
Included
Studies included in review
(n = 13)
Appendix 4 MOH Institutional Review Board Approval
Appendix 5 NIH Course Result 
Appendix 6 KKUH Approval
Appendix 7 Information Sheet for Physicians (focus group)
Research title: Experiences of Expatriate Primary Health Care Physicians in Caring for Type 2 Diabetes Patients in Saudi Arabia: Perspectives of Physicians and Patients
You are invited to take part in a research study exploring the views of expatriate primary health care physicians about the provision of care to people with type 2 diabetes in Riyadh, Saudi Arabia. Please take time to read the following information and feel free to contact me for any further clarification before you decide whether or not you wish to take part. Thank you for reading this.
What is the purpose of the study?
The purpose of this study is to explore expatriate physicians’ experiences and views in regarding to interaction with type 2 diabetes patients in Saudi Arabia. The study is being conducted in two phases. Phase 1 will collect information on physicians’ experiences in interaction with Saudi patients with type 2 diabetes. In Phase 2, interviews will be held with type 2 diabetes patients to explore their side of the interaction experience.
Why have I been chosen?
You have been chosen because you are an expatriate primary health care physician at the King Khalid University Hospital working with diabetes patients.
Do I have to take part?
It is up to you to decide whether or not to take part. If you do decide to take part you will be given this information sheet to keep and asked to sign a consent form. Whether you decide to take part in this study or not, will not affect your professional standing.
What are the possible benefits of taking part?
There are no immediate benefits for participating physicians; however, it is hoped that this work will give you the opportunity to contribute to the development of high quality care based on your responses, as you know that primary health care in Saudi Arabia is provided by majority expatriate physicians, who are needed to meet the demands of the health services.
What will it involve?
It will involve attendance at 1 focus group discussion to be held at the convenience of participants. The focus group will take around 1 hour and take place at the Department Seminar Room. Lunch/refreshments will be provided.
What sort of questions will I be asked?
I will be asking the group to reflect on their experiences of and views about caring for and interacting with Saudi people with type 2 diabetes. Subject to your agreement, I would like to collect some basic demographic information such as age, nationality, length of experience. Consenting participants may be invited to a subsequent interview.
Is the research confidential?
Information from the focus group will be treated confidentially. Although the discussion will not be confidential, your identity will not be revealed to anyone outside the group and will remain anonymous in analysis and reporting of the study. To enhance confidentiality, your name will be replaced by a numerical code. It will not be possible to identify you in any reports or publications. Digital records will be protected by a password. Only I will have access to them. They will be kept until the completion of the transcribing process and then will be destroyed. No information about your identity will be linked to the transcripts.
All participants will be given a copy of the signed consent form.
Will the focus group be recorded?
Yes. With your permission, the focus group discussion will be audio-recorded, for transcription and analysis purposes. No other use will be made of the original recordings. Your identity will be removed from the transcripts and these will be kept strictly confidential.
What will happen with the results?
I will be writing this study for a PhD. Findings will be reported in a range of professional and academic journals, and used to feed into service development in the area of diabetes care.
Who is funding the research?
The research is funded by King Saud University under the supervision of the University of Sheffield, UK. Ethical approval was obtained from School of Health and Related Research, the University of Sheffield and the Saudi Ministry of Health Institutional Review Board in Saudi Arabia.
For further information contact:
Noura Abouammoh
Phone: 0504666115
Email: noura.abouammoh@shef.ac.uk
Thank you for taking the time to read this.
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