Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study

Robin Whittemore,Annel Lozano-Marrufo,Rafael Pérez-Escamilla,Mireya Vilar-Compte,Rosabelle Conover,Selene De La Cerda,Roberta Delvy,Denise Marron

doi:10.1186/s12939-019-1035-x

Robin Whittemore, Annel Lozano-Marrufo + Show 6 more

Open Access

https://doi.org/10.1186/s12939-019-1035-x

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Abstract

BackgroundThe prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.MethodsThis was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.ResultsThe sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers.ConclusionsEvidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.

Highlights

The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets
We identified 8 themes (5 personal challenges shared by providers and adults with T2D, 1 system-level theme endorsed by providers and adults with T2D, 1 system-level theme endorsed by providers, and 1 endorsed by adults with T2D)
Our sample was representative of adults with limited resources who access health care at Seguro Popular clinics [18]

Summary

Introduction

The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. Type 2 diabetes (T2D) is a worldwide public health epidemic with persons in low- and middle-income countries affected disproportionately [1, 2]. The 2016 Mexican Health System Report from the Organization of Economic Cooperation and Development (OECD), highlighted that diabetes prevalence in Mexico reached 15.9%, more than double the OECD average of 6.9% [4]. In Mexico City, a recent study from the Mexican Institute of Public Health [5], revealed that 13.9% of the adult population had T2D. Mortality associated with T2D in Mexico continues to increase; between 1998 and 2008 mortality from T2D doubled [5]

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