Qualitative interviews revealed that the cost of healthy foods and medications are major barriers to diabetes self-management, highlighting the need for tailored education for low-income adults.
Tailored diabetes self-management education addressing financial barriers and community resources is supported by both low-income patients and clinicians.
Introduction and Objective: Low-income adults face barriers to diabetes self-management (DSM) and are less likely to engage in diabetes self-management education and support (DSMES) services. Tailored DSMES content may be more relevant and effective for this population. This qualitative study explored health center patient and clinician perspectives on barriers to DSM and on proposed DSMES tailored for low-income participants. Methods: Semi-structured interviews were conducted with adults with type 2 diabetes (T2D) and clinicians. Interviews queried patient barriers to healthy eating, exercise, glucose monitoring, medication adherence, and stress management, and elicited participant attitudes towards tailored DSMES. Interviews were audio recorded, transcribed, and analyzed using the Framework Method; mean duration was 46 minutes. Results: Patient participants with T2D (N=15) had a median (IQR) age of 48 (47, 61) and self-identified as Black (20%), White (47%), or another race (33%); 67% were female, and 60% were Hispanic. Clinician participants (N=5; 2 physicians, 1 dietitian, 1 nurse diabetes educator, and 1 community health worker) were 39 to 58 years old. Patient participants cited cost of healthy foods, glucose testing supplies, and medications, and competing demands such as work and family obligations as important barriers to DSM. Both patient and clinician participants supported tailored DSMES, including shopping and meal planning on a budget, community-based food resources, adjusting medication and glucose monitoring for food scarcity, and resources for medication discounts. Conclusion: In this qualitative study, barriers to DSM included the cost of healthy foods and medications. A DSMES program tailored for low-income adults could include education about healthy eating on a budget, community food resource referrals, and provision of medication discounts to improve relevance for this population. Disclosure K. Gu: None. D. Wexler: Other - Data Monitoring Committee; Ended; Novo Nordisk. Other - Data Monitoring Committee; Current; Amgen Inc. A. Thorndike: None. Funding National Institutes of Health (F32DK141094)
Gu et al. (Fri,) conducted a other in Type 2 diabetes (n=20). Tailored diabetes self-management education and support (DSMES) was evaluated on Patient and clinician perspectives on barriers to diabetes self-management and tailored DSMES. Qualitative interviews revealed that the cost of healthy foods and medications are major barriers to diabetes self-management, highlighting the need for tailored education for low-income adults.
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