The big challenge out here is getting stuff: How the social determinants of health affect diabetes self-management education for seniors
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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
Resumen
No Canadá, programas de educação para o autocuidado da diabetes (PEAD) são oferecidos para permitir que indivíduos com diabetes implementem e sustentem mudanças de estilo de vida com sucesso, com o objetivo de reduzir o risco de complicações e morbidade. Pesquisadores demonstraram como os idosos com diabetes muitas vezes não conseguem alcançar ou manter as competências necessárias para o autocuidado da diabetes, aumentando assim o risco de desenvolver complicações. Além disso, pouco se sabe sobre a influência dos determinantes sociais da saúde (DSS) no PEAD, potencialmente produzindo desigualdades adicionais para idosos com diabetes. O objetivo desse estudo foi entender melhor como o DSS influencia a implementação dos PEAD em idosos que vivem com diabetes. Métodos: Nosso estudo qualitativo foi uma combinação de metodologias de pesquisa participativa, baseada em arte e fenomenologia-hermenêutica. A coleta de dados incluiu foto voz e entrevistas semiestruturadas via telefone. Quatorze idosos com diabetes (11 homens, 3 mulheres; com 65 anos ou mais) consentiram em participar do estudo. O framework DSS proposto por Loppie-Reading e Wien orientou a análise temática. Resultados: Os achados iluminam como os participantes convivem com os efeitos e pressões dos DSS. Os determinantes próximos da saúde revelados nas histórias dos participantes incluíram comportamentos de saúde (práticas de autocuidado da diabetes), ambientes físicos (ruralidade), status socioeconômico (renda) e insegurança alimentar (acesso a alimentos saudáveis). Os determinantes intermediários incluíram sistemas de saúde (acesso ao PEAD em sua comunidade) e recursos e capacidades da comunidade (infraestrutura limitada devido à ruralidade). Os determinantes distais envolveram a pandemia (isolamento por restrições de mobilização). Conclusão: Nosso estudo demonstrou como os DSS afetam os PEAD e o autocuidado de idosos com diabetes. Os participantes deste estudo relataram estar continuamente reorganizando suas necessidades de diabetes para acomodar outras prioridades de vida. Além disso, a vida rural é descrita como uma barreira para o autocuidado da diabetes, pois o acesso à educação, alimentos, medicamentos e gás é mais limitado devido à distância – um inconveniente particular durante o inverno Canadense. Acreditamos que nossas descobertas servirão para orientar o planejamento e implementação futuros de PEAD para idosos vivendo em um ambiente rural.
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