Challenges to developing diabetes self-management skills in a low-income sample in North Carolina, USA

Abstract

High rates of diabetes diagnosis and poor diabetes outcomes are particularly significant in low-income, socially disadvantaged populations. Although many social and economic predictors of poor self-management outcomes are known, few studies have examined how these elements impact the ability to develop self-management capacities in low-income populations. This article presents new insights into low-income women’s challenges and successes to becoming more adept self-managers. Interview data were collected in 2012 with a sample of low-income, middle-age women with type II diabetes recruited from a non-profit medical clinic serving low-income clients in North Carolina, United States. Data were analysed using a grounded theory approach. Developing self-management skills within disadvantaged life contexts involved negotiating three related, overlapping sub-processes: negotiating access to care systems, negotiating disruptions to diabetes self-management patterns, and negotiating self-care knowledge. Developing diabetes self-management skills is a long and arduous process. Data and analysis presented here help explain how disadvantaged life contexts can impact self-managers’ efforts to develop self-management skills and why continued support is important for reducing and preventing future problems. These initial findings suggest that future studies and intervention development on the topic are warranted.

<p>Barriers to Self-Management of Type 2 Diabetes During COVID-19 Medical Isolation: A Qualitative Study</p>

“…19 Promoting effective diabetes self-management has long been a challenging issue for the health systems, healthcare providers, community workers, and patients with diabetes. 20 Although the data regarding diabetes management for T2DM patients recovering from COVID-19 during isolation remain scarce, notably, previous studies have reported that among Chinese T2DM patients, only 22.76%-40.09% have achieved optimal glycemic control (hemoglobin A1c level<7.0%, 53 mmol/mol) [21][22][23] and 9.20%-16.43% have manifested good self-management behaviors. 21,24 This raises the issue of how to identify factors that hinder diabetes selfmanagement and to address these potential barriers.…”

A Comparison of Functional Features in Chinese and US Mobile Apps for Diabetes Self-Management: A Systematic Search in App Stores and Content Analysis

“…The care includes lifestyle modification (eg, diet, physical activity, and weight management), glucose monitoring, prevention of complications, and multiple medication regimens [7,8]. Barriers to the effectiveness of diabetes care include insufficient knowledge and training that patients received [9], requiring permanent behavior change [10], financial burden [11], and complication-specific treatments [12]. Patient education and support by a multidisciplinary team of professionals (eg, physicians, nurses, dietitians, and psychotherapists) may help improve the quality of care [13], although they could be costly and unavailable in some developing countries [14].…”

Integrating the Science of Habit

“…Even under times of stress, habitual behaviors are more likely to be consistently engaged in than non-habitual behaviors as long as performance contexts remain relatively stable (Neal, Wood, & Drolet, 2013). Unstable or highly variable life context (e.g., shift work, sudden changes in employment or caregiving status) may significantly disrupt habit development (Fritz, 2014a).…”