Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India

Bhojani, Upendra; Mishra, Arima; Amruthavalli, Subramani; Devadasan, Narayanan; Kolsteren, Patrick; Henauw, Stefaan De; Criel, Bart

doi:10.3402/gha.v6i0.22258

Cited by 44 publications

(79 citation statements)

References 13 publications

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“…Studies included in this review were conducted in South America (29, 36, 39), Africa (27, 31, 33–35), Asia (28, 30, 38), Eastern Europe (26, 32), and cross-country studies conducted in different regions (37, 40). The publication years ranged from 2008 to 2014, while data for the secondary analysis by Gakidou et al (37) were collected between 1994 (in Mexico) and 2008 (in Thailand).…”

Section: Resultsmentioning

confidence: 99%

“…The publication years ranged from 2008 to 2014, while data for the secondary analysis by Gakidou et al (37) were collected between 1994 (in Mexico) and 2008 (in Thailand). We included seven quantitative studies (34–40), six qualitative studies (26–28, 31–33), and two mixed-method studies (29, 30). In the mixed-method studies, only the qualitative components met the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Study method, approach, design, recruitment strategy, data collection methods, and ethics considerations were appropriate in all the qualitative studies included in this review. Seven out of eight qualitative studies clearly addressed the researcher’s position and included a rigorous data analysis (26–28, 31–33). Further details on quality assessment for qualitative studies are shown in Table 5.…”

Section: Resultsmentioning

confidence: 99%

“…The determinants of health evaluated in the included studies were place of residence ( N =6) (26, 31–33, 35, 36), race/ethnicity ( N =2) (29, 38), occupation ( N =1) (35), gender ( N =7) (28, 31, 35–38, 40), socio-economic status/income ( N =12) (26–36, 38), and social capital ( N =6) (27, 28, 30–33). None of the studies examined the association between religion and access to medication.…”

Section: Resultsmentioning

confidence: 99%

“…We found five quantitative studies (35–38, 40) and one qualitative study (28) that examined the differences in being treated with any diabetes medication, between men and women.…”

Section: Resultsmentioning

confidence: 99%

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Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Christiani

Dhippayom

Chaiyakunapruk

2016

Global Health Action

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BackgroundInequalities in access to medications among people diagnosed with diabetes inlow- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death.ObjectiveTo assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs.DesignWe conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases – PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE – was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others).ResultsFifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications.ConclusionsThe review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…We found five quantitative studies (35–38, 40) and one qualitative study (28) that examined the differences in being treated with any diabetes medication, between men and women.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Christiani

Dhippayom

Chaiyakunapruk

2016

Global Health Action

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Population Preferences for Primary Care Models for Hypertension in Karnataka, India

et al. 2023

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ImportanceHypertension contributes to more than 1.6 million deaths annually in India, with many individuals being unaware they have the condition or receiving inadequate treatment. Policy initiatives to strengthen disease detection and management through primary care services in India are not currently informed by population preferences.ObjectiveTo quantify population preferences for attributes of public primary care services for hypertension.Design, Setting, and ParticipantsThis cross-sectional study involved administration of a household survey to a population-based sample of adults with hypertension in the Bengaluru Nagara district (Bengaluru City; urban setting) and the Kolar district (rural setting) in the state of Karnataka, India, from June 22 to July 27, 2021. A discrete choice experiment was designed in which participants selected preferred primary care clinic attributes from hypothetical alternatives. Eligible participants were 30 years or older with a previous diagnosis of hypertension or with measured diastolic blood pressure of 90 mm Hg or higher or systolic blood pressure of 140 mm Hg or higher. A total of 1422 of 1927 individuals (73.8%) consented to receive initial screening, and 1150 (80.9%) were eligible for participation, with 1085 (94.3%) of those eligible completing the survey.Main Outcomes and MeasuresRelative preference for health care service attributes and preference class derived from respondents selecting a preferred clinic scenario from 8 sets of hypothetical comparisons based on wait time, staff courtesy, clinician type, carefulness of clinical assessment, and availability of free medication.ResultsAmong 1085 adult respondents with hypertension, the mean (SD) age was 54.4 (11.2) years; 573 participants (52.8%) identified as female, and 918 (84.6%) had a previous diagnosis of hypertension. Overall preferences were for careful clinical assessment and consistent availability of free medication; 3 of 5 latent classes prioritized 1 or both of these attributes, accounting for 85.1% of all respondents. However, the largest class (52.4% of respondents) had weak preferences distributed across all attributes (largest relative utility for careful clinical assessment: β = 0.13; 95% CI, 0.06-0.20; 36.4% preference share). Two small classes had strong preferences; 1 class (5.4% of respondents) prioritized shorter wait time (85.1% preference share; utility, β = −3.04; 95% CI, −4.94 to −1.14); the posterior probability of membership in this class was higher among urban vs rural respondents (mean [SD], 0.09 [0.26] vs 0.02 [0.13]). The other class (9.5% of respondents) prioritized seeing a physician (the term doctor was used in the survey) rather than a nurse (66.2% preference share; utility, β = 4.01; 95% CI, 2.76-5.25); the posterior probability of membership in this class was greater among rural vs urban respondents (mean [SD], 0.17 [0.35] vs 0.02 [0.10]).Conclusions and RelevanceIn this study, stated population preferences suggested that consistent medication availability and quality of clinical assessment should be prioritized in primary care services in Karnataka, India. The heterogeneity observed in population preferences supports considering additional models of care, such as fast-track medication dispensing to reduce wait times in urban settings and physician-led services in rural areas.

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Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

Nanda,

Sharma

2023

Health Care Science

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BackgroundDiabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out‐of‐pocket health expenditure (OOPE) and financial burden associated with DM care in India.MethodsThe study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.ResultsIn India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM‐affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5‐fold and 2.5‐fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities.ConclusionThe burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

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Constraints faced by urban poor in managing diabetes care: patients’ perspectives from South India

Cited by 44 publications

References 13 publications

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Population Preferences for Primary Care Models for Hypertension in Karnataka, India

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

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