Socioeconomic disparities in access to intensive insulin regimens for adults with type 1 diabetes: a qualitative study of patient and healthcare professional perspectives

Abstract

Background Type 1 diabetes is a complex chronic condition which requires lifelong treatment with insulin. Health outcomes are dependent on ability to self-manage the condition. Socioeconomic inequalities have been demonstrated in access to treatment and health outcomes for adults with type 1 diabetes; however, there is a paucity of research exploring how these disparities occur. This study explores the influence of socioeconomic factors in gaining access to intensive insulin regimens for adults with type 1 diabetes. Methods We undertook a qualitative descriptive study informed by a phenomenological perspective. In-depth face-to-face interviews were conducted with 28 patients and 6 healthcare professionals involved in their care. The interviews were analysed using a thematic approach. The Candidacy theory for access to healthcare for vulnerable groups framed the analysis. Results Access to intensive insulin regimens was through hospital-based specialist services in this sample. Patients from lower socioeconomic groups had difficulty accessing hospital-based services if they were in low paid work and because they lacked the ability to navigate the healthcare system. Once these patients were in the specialist system, access to intensive insulin regimens was limited by non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication. These factors could also affect access to structured diabetes education which itself improved access to intensive insulin regimens. Contact with diabetes specialist nurses and attendance at structured diabetes education courses could ameliorate these barriers. Conclusions Access to intensive insulin regimens was hindered for people in lower socioeconomic groups by a complex mix of factors relating to the permeability of specialist services, ability to navigate the healthcare system and patient interactions with healthcare providers. Improving access to diabetes specialist nurses and structured diabetes education for vulnerable patients could lessen socioeconomic disparities in both access to services and health outcomes.

Barriers to Technology Use and Endocrinology Care for Underserved Communities With Type 1 Diabetes

“…morbidity, and mortality (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Race and ethnic minority status further compound disparate outcomes for non-Hispanic Black (NHB) and Hispanic communities with type 1 diabetes as risks for living in poverty and economic deprivation are two times higher than for White communities (13).…”

Development of an Insulin Pen is a Patient-Centric Multidisciplinary Undertaking: A Commentary

“…It is important for engineers and device designers to understand that patient priorities and barriers to therapy can vary greatly according to socioeconomic and educational status. 1 In a descriptive study of patients with type 1 diabetes (T1D), those in lower socioeconomic groups faced difficulties accessing care if they were in low-paid work, and displayed poor health literacy. 1 Some of these patients reported low motivation for diabetes management and did not always follow clinical recommendations.…”

“… 1 In a descriptive study of patients with type 1 diabetes (T1D), those in lower socioeconomic groups faced difficulties accessing care if they were in low-paid work, and displayed poor health literacy. 1 Some of these patients reported low motivation for diabetes management and did not always follow clinical recommendations. 1 For some, putting a “simple” written instruction for use into practice might represent a huge hurdle.…”

“… 1 Some of these patients reported low motivation for diabetes management and did not always follow clinical recommendations. 1 For some, putting a “simple” written instruction for use into practice might represent a huge hurdle. To help ensure that new devices will successfully address issues important to patients and carers, patient/carer input on product concepts and designs should be sought at an early stage of the device development.…”

The Ongoing Transmutation of Type 1 Diabetes: Disparities in Care and Outcomes

“…The chasm is widening between those who have and those who do not have the financial resources, numeracy skills and social and school supports needed to access these technologies and to realize their potential benefits (4). In adults with T1D, drivers of the socioeconomic disparities in access to diabetes technology include the inability to navigate the health-care system, nonalignment with health-care professional goals, poor health literacy, psychosocial problems and poor-quality communication (6). In children and youth, developmental and maturational difficulties further compound these issues.…”