“That wasn't really a place to worry about diabetes”: Housing access and diabetes self-management among low-income adults

Abstract

Lack of affordable housing access represents a significant and growing problem for low-income households in the United States and these housing challenges may present barriers to the management of chronic diseases such as type 2 diabetes. In this qualitative study, we examined how both housing challenges and housing resources shaped diabetes self-management behaviors. We conducted semi-structured interviews with 40 low-income residents of one US city, New Haven, Connecticut, who had a diagnosis of type 2 diabetes and either resided in or qualified for subsidized housing. We purposively constructed our sample to include a range of housing experiences (subsidized, unsubsidized, homeless) and treatment regimes. We analyzed the data using grounded theory techniques of inductive coding and memo writing. Our findings suggest multiple ways that housing access can affect diabetes self-management with implications for blood glucose levels and future complications. Specifically, we describe the ways that housing access affected participants' ability to: 1) prioritize their diabetes care, 2) establish and maintain diabetes routines, and 3) afford diabetes-related expenses. Together, our findings show how housing challenges increased the cost of adherence to diabetes management regimes such that inadequately housed individuals had to both invest and sacrifice more for the same outcomes. Our findings suggest that improved affordable housing access may represent an opportunity to improve outcomes and reduce socioeconomic disparities among those living with type 2 diabetes.

Eviction From Renter-occupied Households and Rates of Sexually Transmitted Infections: A County-level Ecological Analysis

“…3–5 Other research demonstrates that challenges associated with maintaining stable housing can consume emotional and physical energy in ways that may marginalize health concerns. 8 Furthermore, research finds that residential mobility can disrupt engagement in healthcare, resulting in missed appointments and lack of medication adherence, 7 and therefore, potentially reduced rates of STI testing that increases duration of infection and ongoing transmission.…”

“…3–5 Housing instability can also present barriers to chronic disease management and lead to higher levels of emergency department use and inpatient hospital stays. 4,6–8…”

Housing and Food Insecurity and Chronic Disease Among Three Racial Groups in Hawai'i

“…The findings in this study align with those of other studies. Mau and colleagues in their 2010 process evaluation of a pilot translation of a diabetes prevention program found food access and cost were major social influences in NHOPI food consumption (16), which could affect diabetes prevention (7) and management (17,18). Another national study exploring health indicators for NHOPIs analyzed sex and ethnic differences in meeting fruit and vegetable consumption recommendations (19) but did not assess food security to help contextualize food purchasing decisions.…”

Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT

“…11 However, long-term maintenance of diabetes control is still an issue for some individuals even after DSME courses are completed. 12 Inequities found in the social determinants of health add to the struggles of diabetes management including low-income, 13 inadequate housing, 14 behavioral health needs, 15 and lack of health insurance. 16 In addition, lack of resources/support for medications and doctor visits, 17 transportation, 4 day labor jobs/choice between work and doctor visits, 18 culture and language capabilities 19 are other barriers to diabetes self-management found among Mexican American populations.…”