The big challenge out here is getting stuff: How the social determinants of health affect diabetes self-management education for seniors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
https://orcid.org/0000-0002-8349-7723
Madison Robertson
https://orcid.org/0000-0001-5984-8098
Idevania Costa
https://orcid.org/0000-0001-8024-2074
Geneviève Paré
https://orcid.org/0000-0002-3714-9744
Beatriz Alvarado
https://orcid.org/0000-0002-1269-405X
Lenora Duhn
https://orcid.org/0000-0002-0401-953X
Abstract
In Canada, diabetes self-management education (DSME) programs are offered to enable individuals with diabetes to successfully implement and sustain lifestyle changes, with the goal of reducing risk of complications and morbidity. Researchers have demonstrated how older adults with diabetes often fail to achieve or maintain diabetes self-management (DSM) competencies, increasing complication risk. Further, little is known about the influence of the social determinants of health (SDH) on DSME, potentially producing additional inequalities for these adults; the WHO defines SDH as non-medical factors (e.g., education; food insecurity) that impact health outcomes. The study goal was to better understand how the SDH affect DSME for older adults living with diabetes. Methods: In our qualitative study we used participatory, art-based, and hermeneutic phenomenology research methodologies. Data collection included photovoice and semi-structured phone interviews. Fourteen older adults with diabetes participated (11 men, 3 women; aged 65 years or older). A SDH framework (Loppie-Reading and Wien) guided the thematic analysis. Results: The findings illuminate how participants live with the effects and pressures of the SDH. Proximal determinants of health revealed in participants’ stories included health behaviours (diabetes self-management practices), physical environments (rurality), socioeconomic status (income), and food insecurity (accessing healthy food). Intermediate determinants comprised health-care systems (accessing DSME in their community) and community resources and capacities (limited infrastructure due to rurality). Distal determinants involved the pandemic (isolation due to mobilization restrictions). Conclusion: Our study demonstrated how the SDH affect DSME and DSM for older adults. Participants were continuously rearranging their diabetes needs to accommodate other life priorities. Additionally, rural living is described as a barrier to DSM, as accessing diabetes education, food, medications, and gas is at a distance—a particular inconvenience during wintertime. Our findings will guide future design, planning and implementation of DSME programs for older adults in this rural setting.
##plugins.themes.bootstrap3.article.details##
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
openAccess
Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B.S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLoS One, 14(6), e0217771. https://doi.org/ 10.1371/journal.pone.0217771
Agarwal, G., Habing, K., Pirrie, M., Angeles, R., Marzanek, F., & Parascandalo, J. (2018). Assessing health literacy among older adults living in subsidized housing: A cross-sectional study. Canadian Journal of Public Health, 109(3), 401-409. https://doi.org/10.17269/s41997-018-0048-3
Arcury, T. A., Bell, R. A., Snively, B. M., Smith, S. L., Skelly, A.H., Wetmore, L. K., & Quandt, S. A. (2006). Complementary and alternative medicine use as health self-management: Rural older adults with diabetes. The Journals of Gerontology: Series B, 61(2), S62–S70. https://doi.org/10.1093/geronb/61.2.s62
Beverly, E. A., Ritholz, M. D., Wray, L. A., Chiu, C. J., & Suhl, E. (2018). Understanding the meaning of food in people with Type 2 diabetes living in northern Appalachia. Diabetes spectrum: A publication of the American Diabetes Association, 31(1), 14-24. https://doi.org/10.2337/ds16-0059
Carolan-Olah, M., Holman, J., & Ferrari, M. (2014). Experiences of diabetes self-management: A focus group study among Australians with type 2 diabetes. Journal of Clinical Nursing, 24 (7-8), 1011-1023. https://doi.org/10.1111/jocn.12724
Cauch-Dudek, K., Victor, J. C., Sigmond, M., & Shah, B. R. (2013). Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: A cohort study. BMC Public Health, 13, 85. https://doi.org/10.1186/1471-2458-13-85
Centers for Disease Control and Prevention (2021). Diabetes and mental health. https://www.cdc.gov/diabetes/managing/mental-health.html
Chan, J., DeMelo, M., Gingras, J., & Gucciardi, E. (2015). Challenges of diabetes self-management in adults affected by food insecurity in a large urban centre of Ontario, Canada. International Journal of Endocrinology, 2015, Article ID 903468. https://doi.org/10.1155/2015/903468
Chard, S., Henderson, L., Wallace, B. H., Roth, E. G., Girling, L., & Eckert, J. K. (2021). “How I can help me”: Self-Care priorities and structural pressures among black older adults with diabetes. The Gerontologist, gnab157. https://doi.org/10.1093/geront/gnab157
Clark, M. L., & Utz, S. W. (2014). Social determinants of Type 2 diabetes and health in the United States. World Journal of Diabetes, 5(3), 296–304. https://doi.org/10.4239/wjd.v5.i3.296
Costa, I. G., Camargo-Plazas, P., & Tregunno, D. (2017). Re-thinking self-care management for individuals with diabetic foot ulcers. Wounds International Journal, 8(2), 10-14.
Costa, I. G., Tregunno, D., & Camargo-Plazas, P. (2021). Patients’ journey toward engagement in self-management of diabetic foot ulcer in adults with Types 1 and 2 diabetes: A constructivist grounded theory study. Canadian Journal of Diabetes, 45(2), 108-113. https://doi.org/10.1016/j.jcjd.2020.05.017
Diabetes Canada Clinical Practice Guidelines Expert Committee. (2018). Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada. Canadian Journal of Diabetes, 42(Suppl 1), S1-S326.
Etowa, J. B., Thomas Bernard, W., Oyinsan, B., & Clow, B. (2007). Participatory Action Research (PAR): An Approach for improving black women’s health in rural and remote communities. Journal of Transcultural Nursing, 18(4), 349-357.
Freire, P. (2013). Education for critical consciousness. Bloomsbury Academic.
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., Haire-Joshu, D. (2021). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258-279. https://doi.org/10.2337/dci20-0053
Homenko, D. R., Morin, P. C., Eimicke, J. P., Teresi, J. A., & Weinstock, R. S. (2010). Food insecurity and food choices in rural older adults with diabetes receiving nutrition education via telemedicine. Journal of Nutrition Education and Behavior, 42, 404-409. https://doi.org/10.1016/j.jneb.2009.08.001
Hsu, C. C., Lee, C. H., Wahlqvist, M. L., Huang, H. L., Chang, H. Y., Chen, L., Shih, S. F., Shin, S. J,, Tsai, W. C., Chen, T., Huang, C. T., & Cheng, J. S. (2012). Poverty increases type 2 diabetes incidence and inequality of care despite universal health coverage. Diabetes Care, 35(11), 2286-92. https://doi.org/10.2337/dc11-2052
International Diabetes Foundation (IDF). (2021). IDF Diabetes Atlas (10th ed.). https://diabetesatlas.org/atlas/tenth-edition/?dlmodal=active&dlsrc=https%3A%2F%2Fdiabetesatlas.org%2Fidfawp%2Fresource-files%2F2021%2F07%2FIDF_Atlas_10th_Edition_2021.pdf
International Diabetes Federation (IDF). (2020). IDF: Type 2 diabetes. https://www.idf.org/aboutdiabetes/type-2-diabetes.html
Kidd, S., Davidson, L., Frederick, T., & Kral, M. J. (2018). Reflecting on participatory, action-oriented research methods in community psychology: Progress, problems, and paths forward. American Journal of Community Psychology, 61(1-2), 76-87. doi:10.1002/ajcp.12214
Kirk, J. K., Arcury, T. A., Ip, E., Bell, R. A., Saldana, S., Nguyen, H. T., & Quandt, S. A. (2015). Diabetes symptoms and self-management behaviors in rural older adults. Diabetes Research and Clinical Practice, 107(1), 54-60. https://doi.org/10.1016/j.diabres.2014.10.005
Lincoln, Y. S., & Guba E. G. (1985). Naturalistic Inquiry. Sage.
Loppie-Reading, C., & Wien, F. (2013). Health inequalities and social determinants of Aboriginal people’s health. National Collaborating Centre for Aboriginal Health (NCCAH). https://www.nccih.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf
Lutfiyya, M. N., McCullough, J. E., Mitchell, L., Dean, L. S., & Lipsky, M. S. (2011). Adequacy of diabetes care for older U.S. rural adults: A cross-sectional population-based study using 2009 BRFSS data. BMC Public Health, 11, 940. https://doi.org/10.1186/1471-2458-11-940
Markle-Reid, M., Ploeg, J., Fraser, K. D., Fisher, K. A., Bartholomew, A., Griffith, L. E., Miklavcic, J., Gafni, A., Thabane, L., & Upshur, R. (2018). Community program improves quality of life and self-management in older adults with diabetes mellitus and comorbidity. Journal of the American Geriatrics Society, 66(2), 263-273. https://doi.org/10.1111/jgs.15173
Ndjaboue, R., Chipenda Dansokho, S., Boudreault, B., Tremblay, M. C., Dogba, M. J., Price, R., Delgado, P., McComber, A. M., Drescher, O., McGavock, J., & Witteman, H. (2020). Patients' perspectives on how to improve diabetes care and self-management: Qualitative study. BMJ Open, 10, e032762. https://dx.doi.org/10.1136/bmjopen-2019-032762
Park, H., & Wenzel, J.A. (2013). Experience of social role strain in Korean women with Type 2 diabetes. Journal of Advanced Nursing, 69(6), 1400-1409. https://doi.org/10.1111/jan.12001
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Maryniuk, M. D., Siminerio, L., & Vivian, E. (2016). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical Diabetes: A publication of the American Diabetes Association, 34(2), 70-80. https://doi.org/10.2337/diaclin.34.2.70
Public Health Agency of Canada. (2018). Key health inequalities in Canada: A national portrait. https://www.canada.ca/en/public-health/services/publications/science-research-data/inequalities-diabetes-infographic.html
Public Health Agency of Canada. (2020). Aging and chronic diseases: A profile of Canadian seniors.
Saunders, T. (2019). Type 2 diabetes self-management barriers in older adults: An integrative review of the qualitative literature. Journal of Gerontological Nursing, 45(3), 43-54. http://dx.doi.org/10.3928/00989134-20190211-05
Seligman, H. K., Jacobs, E. A., López, A., Tschann, J., & Fernandez, A. (2012). Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care, 35(2), 233-238. https://doi.org/10.2337/dc11-1627
Sherifali, D., Bai, J.W., Kenny, M., Warren, R., & Ali, M.U. (2015). Diabetes self-management programmes in older adults: A systematic review and meta-analysis. Diabetic Medicine, 32(11), 1404-1414. https://doi.org/10.1111/dme.12780
Speight, J., & Singh, H. (2013). The journey of the person with diabetes. In T. Dunning (Ed.), Diabetes care education: Art, science and evidence (pp. 12-27). Wiley-Blackwell.
Statistics Canada. (2021a). Diabetes, by age group. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009607
Statistics Canada. (2021b). Population estimates, quarterly. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901&cubeTimeFrame.startMonth=01&cubeTimeFrame.startYear=2020&cubeTimeFrame.endMonth=10&cubeTimeFrame.endYear=2020&referencePeriods=20200101%2C20201001
Tanaka, T., Gjonça, E., & Gulliford, M. C. (2012). Income, wealth and risk of diabetes among older adults: Cohort study using the English longitudinal study of ageing. European Journal of Public Health, 22(3), 310-317. https://doi.org/10.1093/eurpub/ckr050
Tong, W. T., Vethakkan, S. R., & Ng, C. J. (2015). Why do some people with type 2 diabetes who are using insulin have poor glycaemic control? A qualitative study. BMJ Open, 5, e006407. https://doi.org/10.1136/bmjopen-2014-006407
van Manen, M. (2014). Phenomenology of practice. Meaning-giving methods in phenomenological research and writing. Left Coast Press.
van Manen. (2016). Researching lived experience: Human science for an action sensitive pedagogy (2nd.). Routledge.
Vest, B. M., Kahn, L. S., Danzo, A., Tumiel-Berhalter, L., Schuster, R. C., Karl, R., Taylor, R., Glaser, K., Danakas, A., & Fox, C. H. (2013). Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system. Chronic Illness, 9(2), 145-155. https://doi.org/10.1177/1742395313475674
Wang, C. & Burris, M.A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369-387.
World Health Organization (WHO). (2021). Diabetes – Key facts. https://www.who.int/news-room/fact-sheets/detail/diabetes