Abstract
IntroductionDiabetes self-management takes place within a complex social and environmental context. This study’s objective was to examine the perceived and actual presence of community assets that may aid in diabetes control.MethodsWe conducted one 6-hour photovoice session with 11 adults with poorly controlled diabetes in Boston, Massachusetts. Participants were recruited from census tracts with high numbers of people with poorly controlled diabetes (diabetes “hot spots”). We coded the discussions and identified relevant themes. We further explored themes related to the built environment through community asset mapping. Through walking surveys, we evaluated 5 diabetes hot spots related to physical activity resources, walking environment, and availability of food choices in restaurants and food stores.ResultsCommunity themes from the photovoice session were access to healthy food, restaurants, and prepared foods; food assistance programs; exercise facilities; and church. Asset mapping identified 114 community assets including 22 food stores, 22 restaurants, and 5 exercise facilities. Each diabetes hot spot contained at least 1 food store with 5 to 9 varieties of fruits and vegetables. Only 1 of the exercise facilities had signage regarding hours or services. Memberships ranged from free to $9.95 per month. Overall, these findings were inconsistent with participants’ reports in the photovoice group.ConclusionWe identified a mismatch between perceptions of community assets and built environment and the objective reality of that environment. Incorporating photovoice and community asset mapping into a community-based diabetes intervention may bring awareness to underused neighborhood resources that can help people control their diabetes.
Highlights
Diabetes self-management takes place within a complex social and environmental context
Community themes from the photovoice session were access to healthy food, restaurants, and prepared foods; food assistance programs; exercise facilities; and church
Current recommendations state that interventions for diabetes management should consider the interplay of individual, family, social, and community factors [7]; studies tend to be limited to one of these categories
Summary
Diabetes self-management takes place within a complex social and environmental context. Despite the recent plateau in diabetes prevalence, many people are not achieving clinical goals for diabetes control [1,2]. Effective control requires both medical interventions and self-management, including healthy eating, physical activity, and stress reduction, facilitated by self-efficacy and social support [3]. Many studies have made associations between risk factors for cardiometabolic disease and the built environment, which includes access to healthy food and physical activity resources [4]. Current recommendations state that interventions for diabetes management should consider the interplay of individual, family, social, and community factors [7]; studies tend to be limited to one of these categories
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