Abstract
BackgroundType 2 diabetes is highly prevalent in Canadian First Nations (FN) communities. FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care. They are also less likely to be able to engage in optimal self-management behaviours. While the systemic and racial contributors to this problem have been well described, individuals’ experiences with structural barriers to care and self-management remain under-characterized.MethodsWe utilized qualitative methods to gain insight into the structural barriers to self-management experienced by FN individuals with diabetes. We conducted a qualitative descriptive analysis of a subcohort of patients with diabetes from FN communities (n = 5) from a larger qualitative study. Using detailed semi-structured telephone interviews, we inquired about participants’ diabetes and barriers to diabetes self-management. Inductive thematic analysis was performed in duplicate using NVivo 10.ResultsThe structural barriers faced by this population were substantial yet distinct from those described by non-FN individuals with diabetes. For example, medication costs, which are usually cited as a barrier to care, are covered for FN persons with status. The barriers to diabetes self-management that were commonly experienced in this cohort included transportation-related difficulties, financial barriers to uninsured health services, and lack of accessible diabetes education and resultant knowledge gaps.ConclusionsFN Albertans with diabetes face a myriad of barriers to self-management, which are distinct from the Non-FN population. In addition to the barriers introduced by colonialism and historical injustices, finances, geographic isolation, and lack of diabetes education each impede optimal management of diabetes. Programs targeted at addressing FN-specific barriers may improve aspects of diabetes self-management in this population.
Highlights
Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities
Our work was embedded within a larger qualitative study focused on financial barriers to care, where data was collected from 34 participants with cardiovascular-related chronic diseases, which included both FN and non-FN individuals [30]
We explored the structural barriers to diabetes management experienced by 5 participants living in FN communities, who were interviewed as part of the larger study
Summary
FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care They are less likely to be able to engage in optimal self-management behaviours. Kulhawy‐Wibe et al Diabetol Metab Syndr (2018) 10:87 tuberculosis sanatoria [15]; which may result in disengagement from health services [16,17,18,19] Given these disparities and the historical context in which they occur, there is a need to explore the health experiences of FN individuals with diabetes, and identify practices and processes that are required to meet the needs of individual patients and support self-management [20]. Engagement in DM education programs, has been shown to improve diabetes-related outcomes [21] and that self-management support programs are more effective when adapted to overcome barriers faced by specific populations [22]. Prior studies in FN populations with diabetes have focused on identifying gaps in diabetes management and outcomes [24] and provider perspectives about barriers to care [25, 26], leaving a relative knowledge gap on the specific barriers and experiences of FN individuals with diabetes, as related to self-management behaviours
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