Exploring structural barriers to diabetes self-management in Alberta First Nations communities

Kulhawy-Wibe, Stephanie; King‐Shier, Kathryn; Barnabé, Cheryl; Manns, Braden; Hemmelgarn, Brenda R.; Campbell, David

doi:10.1186/s13098-018-0385-7

Cited by 21 publications

(28 citation statements)

References 48 publications

(60 reference statements)

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“…Studies in developed countries such as the United States, Canada, the United Kingdom, and Singapore have found that common barriers to self-management include poor communication between patients and healthcare providers, limited accessibility to healthcare facilities, lack of family support, inadequate disease knowledge and limited disease treatment methods, lack of motivation for change, physical and cognitive disorders, limited access to diabetes education, and financial barriers. [25][26][27][28][29][30][31][32] Evidently, factors that hinder diabetes self-management are complex and multifaceted. However, the barriers to diabetes self-management for patients with diabetes recovering from COVID-19 during their isolation are not precisely known.…”

Section: Introductionmentioning

confidence: 99%

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

Shi¹,

Zhu²,

Li³

et al. 2020

DMSO

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Purpose: Diabetes self-management behaviors are necessary to obtain optimum glycemic control, reduce the risk of complications, and improve health outcomes. The COVID-19 pandemic imposes an additional struggle for self-management by diabetes patients. Although previous studies have reported socio-demographic, behavioral, psychological, and cultural barriers to diabetes self-management, little is known about perceived barriers to diabetes self-management among patients during isolation following their recovery from COVID-19. The purpose of this study was to explore perceived barriers among type 2 diabetes patients during isolation following their recovery from COVID-19. Patients and Methods: A qualitative, exploratory, and descriptive research design was utilized. Semi-structured telephonic interviews were conducted with 12 patients with diabetes who had been discharged from one COVID-19 designated hospital and underwent isolation in the designated facilities in Wuhan City, Hubei Province, China. Data were analyzed using Colaizzi's seven steps. Results: Barriers to diabetes self-management identified by patients with diabetes during isolation were categorized into five major themes: inadequate knowledge and behavioral beliefs, shortage of resources, suffering from health problems, negative emotions, and lack of support. Conclusion: Perceived barriers to diabetes self-management described by diabetes patients indicated a lack of environmental resources and support strategies to meet their needs. Efforts to remove barriers are important in assisting patients with diabetes to improve their quality of life and health outcomes.

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Section: Introductionmentioning

confidence: 99%

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

Shi¹,

Zhu²,

Li³

et al. 2020

DMSO

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“…The authors of a mixed-methods study of 244 health care providers in 19 communities concluded that patient factors were critical but also expressed concern about the risk that this would lead to "patient blaming"; they noted that structural barriers such as the absence of local services or transportation difficulties were also important. 48 Kulhawy-Wibe and colleagues 49 conducted a qualitative study in 5 Alberta First Nations communities and concluded that there were many First-Nations-specific structural barriers to accessing diabetes self-management supports, including lack of local or culturally relevant resources. The Screening for Limb, I-Eye, Cardiovascular and Kidney (SLICK) complications program in Alberta developed mobile screening programs to help mitigate barriers to access, 50 and the Transformation of Indigenous Primary Healthcare Delivery (FORGE AHEAD) program is evaluating quality-improvement interventions in multiple communities across Canada.…”

Section: Discussionmentioning

confidence: 99%

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

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D iabetes and its related complications are major contributors to morbidity and mortality worldwide. 1-3 Indigenous populations in Canada and around the world are disproportionately affected by diabetes owing to the complex relations among colonization, social disadvantage, stress, trauma and metabolic health. 4-7 In addition to our own work showing persistently higher rates of peripheral vascular disease, stroke, cardiac disease, renal dysfunction and ophthalmologic complications in Ontario First Nations, 8-12 other Canadian and international studies also showed higher complication rates in diverse Indigenous populations. 6,7,13-15 Glycemic control is fundamental to the management of diabetes and the prevention of complications. 16 Glycated hemoglobin (A 1c) is a reliable way to estimate the average level of glucose in the blood. 17 Since A 1c levels higher than 7.0% have been associated with an increased risk of microvascular complications, 18-20 treatment guidelines suggest A 1c should be measured every 3-6 months to ensure that glycemic goals are being met or maintained. 21 Since people with diabetes also have an elevated risk for cardiovascular disease, 22-24 management and control of cardiovascular risk factors, particularly lipids such as low-density lipoprotein (LDL) cholesterol, are also important. 25-27 Guidelines further recommend that a full lipid profile be measured every 1-3 years, depending on cardiovascular risk, and suggest that LDL be consistently less than 2.0 mmol/L. 28 Control of A 1c and lipids has been shown to be associated with reduced morbidity and mortality in patients with diabetes. 18,29-32 One possible reason for the high burden of complications among Indigenous people with diabetes may be failure to achieve control of these 2 key clinical parameters. We examined differences between Status First Nations people with diabetes in Ontario and all other Ontario residents with diabetes in rates of monitoring of A 1c and lipids, achievement of targets for A 1c and LDL outlined in clinical guidelines, and patterns of medication use to help attain these targets.

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“…This may be due to other factors described previously, such as poor quality of diabetes care, food insecurity, physical inactivity and diabetes self-management barriers. 21,22 Furthermore, the intergenerational impact of colonization among First Nations people may also have influenced the risk of end-stage kidney disease. 23 In our study, the proportion receiving a kidney transplant was similar between the 2 populations, but, given the higher prevalence of long-term dialysis among First Nations people, this may signify lower transplantation access.…”

Section: Discussionmentioning

confidence: 99%

Kidney disease and care among First Nations people with diabetes in Ontario: a population-based cohort study

Nash

Dirk

McArthur

et al. 2019

cmajo

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bout 2.4 million Canadians are living with diabetes. 1 A serious complication of diabetes is end-stage kidney disease, which has a worse outcome than many advanced cancers and is fatal without life-sustaining treatments such as dialysis or kidney transplantation. 2 In 2017, around 39 000 Canadians were living with end-stage kidney disease. 3 In Ontario primary care, it is a priority to detect kidney disease early and slow the progression to end-stage kidney disease. 4 First Nations people generally have higher rates and an earlier onset of end-stage kidney disease compared to other Canadians. 5-8 However, the prevalence of kidney disease among First Nations people with diabetes in Ontario is not well known. Furthermore, there are few data on the quality of care for early-stage kidney disease delivered by Ontario primary care providers to First Nations people with diabetes and chronic kidney disease. Our study objectives were to describe the prevalence of chronic kidney disease, the prevalence and incidence of end-stage kidney disease, the average distance travelled for in-centre hemodialysis treatment and the quality of care for early-stage kidney disease for First Nations people with diabetes compared to other people in Ontario.

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Exploring structural barriers to diabetes self-management in Alberta First Nations communities

Cited by 21 publications

References 48 publications

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

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

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Kidney disease and care among First Nations people with diabetes in Ontario: a population-based cohort study

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