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Hiyare-Hewage A, Sinka V, Grande ED, Kerr M, Kim S, Mallitt KA, Dickson M, Jaure A, Wilson R, Craig JC, Stephens JH. The cultural safety of research reports on primary healthcare use by Indigenous Peoples: a systematic review. BMC Health Serv Res 2024; 24:873. [PMID: 39085815 PMCID: PMC11293170 DOI: 10.1186/s12913-024-11314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories. METHODS Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. RESULTS We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access. CONCLUSION Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs.
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Affiliation(s)
- Amandi Hiyare-Hewage
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Victoria Sinka
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eleonora Dal Grande
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Michelle Dickson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Rhonda Wilson
- Department of Nursing, RMIT University, Melbourne, Australia
| | - Jonathan C Craig
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jacqueline H Stephens
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Yadav UN, Davis JM, Bennett-Brook K, Coombes J, Wyber R, Pearson O. A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care. Health Res Policy Syst 2024; 22:34. [PMID: 38509612 PMCID: PMC10956197 DOI: 10.1186/s12961-024-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations. METHODS We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to "Aboriginal and Torres Strait Islander peoples," "Chronic Disease," and "Primary Health Care". Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches. RESULTS Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery. CONCLUSION Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | | | | | | | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
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Wang STL, Parkinson A, Butler D, Law HD, Fanning V, Desborough J. Real price of health-experiences of out-of-pocket costs in Australia: protocol for a systematic review. BMJ Open 2022; 12:e065932. [PMID: 36600422 PMCID: PMC9772657 DOI: 10.1136/bmjopen-2022-065932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Australians have substantial out-of-pocket (OOP) health costs compared with other developed nations, even with universal health insurance coverage. This can significantly affect access to care and subsequent well-being, especially for priority populations including those on lower incomes or with multimorbidity and chronic illness. While it is known that high OOP healthcare costs may contribute to poorer health outcomes, it is not clear exactly how these expenses are experienced by people with chronic illnesses. Understanding this may provide critical insights into the burden of OOP costs among this population group and may highlight policy gaps. METHOD AND ANALYSIS A systematic review of qualitative studies will be conducted using Pubmed, CINAHL Complete (EBSCO), Cochrane Library, PsycINFO (Ovid) and EconLit from date of inception to June 2022. Primary outcomes will include people's experiences of OOP costs such as their preferences, priorities, trade-offs and other decision-making considerations. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and methodological appraisal of included studies will be assessed using the Critical Appraisal Skills Programme. A narrative synthesis will be conducted for all included studies. ETHICS AND DISSEMINATION Ethics approval was not required given this is a systematic review that does not include human recruitment or participation. The study's findings will be disseminated through conferences and symposia and shared with consumers, policymakers and service providers, and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022337538.
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Affiliation(s)
- Shelley Ting-Li Wang
- School of Medicine and Psychology, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Danielle Butler
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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McPherson M, Carroll M, Stewart S. Patient-perceived and practitioner-perceived barriers to accessing foot care services for people with diabetes mellitus: a systematic literature review. J Foot Ankle Res 2022; 15:92. [PMID: 36527060 PMCID: PMC9755774 DOI: 10.1186/s13047-022-00597-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Foot-related complications are common in people with diabetes mellitus, however foot care services are underutilized by this population. This research aimed to systematically review the literature to identify patient and practitioner-perceived barriers to accessing foot care services for people with diabetes. METHODS PRISMA guidelines were used to inform the data collection and extraction methods. CINAHL, MEDLINE, and Scopus databases were searched in March 2022 to identify original research articles that reported on barriers to accessing diabetes foot care services from the patient and/or practitioner perspective. Both quantitative and qualitative studies were included. The methodological quality of included studies was assessed using the Critical Appraisal Skills Program (CASP) tool for qualitative/mixed methods studies or the National Heart, Lung & Blood Institute (NHLBI) tool for quantitative studies. Following data extraction, content analysis was used to identify reported barriers. Themes and subthemes were presented separately for patient-perspectives and practitioner-perspectives. A narrative summary was used to synthesize the findings from the included studies. RESULTS A total of 20 studies were included. The majority of CASP and NHLBI criteria were met by most studies, indicating good overall methodological quality. Three predominant themes emerged from the patient perspective that represented barriers to accessing foot care services: lack of understanding, socioeconomic factors, and lack of service availability. Four themes emerged from the practitioner perspective: poor interprofessional communication, lack of resources, lack of practitioner knowledge, and perceived patient factors. CONCLUSIONS This study has identified a number of barriers to accessing foot care services from both the patient and practitioner perspectives. Although patients focused predominantly on patient-level factors, while practitioners focused on barriers related to the health care system, there was some overlap between them. This emphasizes the importance of recognising both perspectives for the future integration of policy changes and access facilitators that may help to overcome these barriers.
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Affiliation(s)
- Megan McPherson
- grid.252547.30000 0001 0705 7067Department of Podiatry, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Matthew Carroll
- grid.252547.30000 0001 0705 7067Department of Podiatry, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand ,grid.252547.30000 0001 0705 7067Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Stewart
- grid.252547.30000 0001 0705 7067Department of Podiatry, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand ,grid.252547.30000 0001 0705 7067Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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5
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Baker K, Adams J, Steel A. Experiences, perceptions and expectations of health services amongst marginalized populations in urban Australia: A meta-ethnographic review of the literature. Health Expect 2021; 25:2166-2187. [PMID: 34904344 PMCID: PMC9615052 DOI: 10.1111/hex.13386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Poor health outcomes amongst marginalized groups result in part from health inequities related to social and structural determinants of health. Marginalized people report higher incidences of comorbidities, chronic disease and adverse health behaviours than their nondisadvantaged peers. The objective of this review is to examine marginalized Australians' experiences of and access to community‐based primary health services in urban locations. Methods A systematic search incorporating related MeSH terms and synonyms pertaining to marginalized Australian populations and their health‐seeking was conducted across seven databases. We included qualitative studies that reported experiences of health‐seeking within community‐based primary health care in metropolitan Australia. Participant populations experiencing marginalization due to social stigma and isolation, early‐life disadvantage, poor health and/or financial hardship were included. A meta‐ethnographic framework was used to synthesize themes across selected studies and researcher triangulation was employed to develop higher‐order themes. Results Search results revealed 26 studies included for critical appraisal and synthesis. Seven higher‐order themes were developed describing experiences of health service engagement amongst marginalized groups: (1) Understanding the patient within the context of family and community, (2) Health and cultural beliefs influence health‐seeking, (3) Lack of information and poor cultural competence limit utilization of services, (4) Motivation for treatment influences health service engagement, (5) Accessing services, a spectrum of experience—from discrimination to validation, (6) Navigating a complex system in a complex society, (7) Preferences for health care and expectations for systemic change. Conclusion Marginalized Australians experience health disadvantage across micro, meso and macro levels of health system navigation and commonalities in health‐seeking were identified across each of the distinct marginalized groups in our analysis. This review outlines important areas of consideration for health care provision and policy development essential to helping address health inequities for a diversity of marginalized populations. Patient or Public Contribution Whilst patient voices were reported across all studies included within this review, no further patient or public contribution applies to this study.
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Affiliation(s)
- Kirsten Baker
- Faculty of Health, School of Public Health, Sydney University of Technology, Sydney, Australia
| | - Jon Adams
- Faculty of Health, School of Public Health, Sydney University of Technology, Sydney, Australia
| | - Amie Steel
- Faculty of Health, School of Public Health, Sydney University of Technology, Sydney, Australia
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Stotz SA, Ricks KA, Eisenstat SA, Wexler DJ, Berkowitz SA. Opportunities for Interventions That Address Socioeconomic Barriers to Type 2 Diabetes Management: Patient Perspectives. Sci Diabetes Self Manag Care 2021; 47:153-163. [PMID: 34078177 DOI: 10.1177/0145721721996291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to explore patient perspectives on socioeconomic barriers related to diabetes self-management and interventions to address these barriers. METHODS Focus groups (n = 8) were conducted with a diverse sample of adults with type 2 diabetes (T2D; n = 53). Researchers used a semistructured moderator guide; focus groups were audio recorded and transcribed verbatim. Researchers employed the constant comparison method for qualitative content analysis and utilized Atlas.ti (Version 8.1.1) to digitalize the analytic process. RESULTS Findings revealed 3 primary themes: (1) Existing food and nutrition resources are insufficient to support healthy eating for diabetes; (2) healthy eating is critical for diabetes management, but socioeconomic circumstances make doing so challenging; and (3) participants supported several broad categories of preferred intervention strategies. First, they endorsed lifestyle intervention informed by socioeconomic status (SES; eg, focusing on food resource management, sensitive health coaching and nutritional counseling). Next, they expressed enthusiasm for group-based learning opportunities, such as cooking classes and support groups with similar SES peers. Finally, they suggested healthy food access resources. CONCLUSIONS Participant suggestions should be incorporated into intervention development. Ultimately, these interventional strategies should be tested and refined to help improve health for individuals with type 2 diabetes.
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Affiliation(s)
- Sarah A Stotz
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Katharine A Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie A Eisenstat
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Deborah J Wexler
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seth A Berkowitz
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of General Medicine & Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Song HJ, Dennis S, Levesque JF, Harris MF. What matters to people with chronic conditions when accessing care in Australian general practice? A qualitative study of patient, carer, and provider perspectives. BMC FAMILY PRACTICE 2019; 20:79. [PMID: 31182041 PMCID: PMC6558875 DOI: 10.1186/s12875-019-0973-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research underpinning the patient experience of people with chronic conditions in Australian general practice is not well developed. We aimed to ascertain the perspectives of key stakeholders on aspects of patient experience, more specifically with regards to accessing general practice in Australia. METHODS Using a qualitative design, semi-structured interviews were conducted by telephone and face-to-face with people living with one or more chronic conditions, informal carers, and primary care providers between October 2016 and October 2017. Participants were recruited and selected from three demographically representative primary health networks across Sydney, Australia. Interview transcripts and researcher's reflective fieldnotes were coded and analyzed for key themes of access. Analysis and interpretation of data were guided by Levesque's model of access, a conceptual framework to evaluate access broadly and from corresponding patient- and provider-side dimensions. RESULTS A total of 40 interviews were included in the analysis. Most participants had attended their general practices for 10 years or more and had regular primary care providers. People with chronic conditions reported access barriers predominantly in their ability to reach services, which were related to illness-related disabilities (limited mobility, chronic pain, fatigue, frailty) and limitations in the availability and accommodation of health services to address patient preferences (unavailability of after-hours services, lack of alternative modes of service delivery). While cost was not a major barrier, we found a lack of clarity in the factors that determined providers' decisions to waive or reduce costs for some patients and not others. CONCLUSIONS People managing chronic conditions with a long-term primary care provider experienced access barriers in general practice, particularly in their ability to physically reach care and to do so on a timely basis. This study has important policy and practice implications, as it highlights patients' experiences of accessing care and possible areas for improvement to appropriately respond to these experiences. Themes identified may be useful in the design of a patient experience survey tool specific to this population. While it incorporates perspectives from patients, carers and providers, this study could be further strengthened by including perspectives from culturally and linguistically underrepresented patient groups and more carers.
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Affiliation(s)
- Hyun Jung Song
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sarah Dennis
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Jean-Frédéric Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- Agency for Clinical Innovation, Chatswood, New South Wales Australia
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Villalba C, Jaiprakash A, Donovan J, Roberts J, Crawford R. Unlocking the Value of Literature in Health Co-Design: Transforming Patient Experience Publications into a Creative and Accessible Card Tool. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 11:637-648. [PMID: 29802539 DOI: 10.1007/s40271-018-0315-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND A wealth of peer-reviewed data exists regarding people's health experience, yet practical ways of using the data to understand patients' experiences and to inform health co-design are needed. OBJECTIVE This study aims to develop an applied and pragmatic method for using patient experience literature in co-design by transforming it into an accessible and creative co-design tool. METHOD A scoping literature review of the CINAHL, MEDLINE, PsycINFO and PubMed electronic databases was conducted from January 2011 through August 2016. Qualitative publications regarding the experience of living with diabetes in Australia were selected. The Results section of each paper was extracted and affinity analysis was applied to identify insights into the health experience. These insights were developed into a card tool for use in health co-design activities. RESULTS Thirteen relevant papers were identified from the review, and affinity analysis of the Results sections of these papers lead to the identification of 85 insights, from 'Shock of diagnosis' (Insight 1), to 'Delay seeking care' (Insight 9), to 'Assess the quality of care' (Insight 28), to 'Avoid or adapt habits' (Insight 78). Each insight was developed into an individual card, which included a high-level theme, insight, quote and a link back to the literature, together making up the Health Experience Insight Cards, Living with Diabetes Edition. CONCLUSIONS This was the first study to develop a method for transforming existing patient experience literature into a creative tool for health improvement. The Health Experience Insight Cards collate the diverse experiences of over 300 people living with diabetes in Australia, from 13 studies. Health improvement teams can use the 'Living with Diabetes Edition' cards or they can follow this pragmatic method to create their own cards focused on other health experiences to facilitate person-focused health improvements.
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Affiliation(s)
- Clare Villalba
- Medical and Healthcare Robotics, Queensland University of Technology, Brisbane, QLD, Australia
| | - Anjali Jaiprakash
- Medical and Healthcare Robotics, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Jared Donovan
- Design Lab, Creative Industries Faculty, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jonathan Roberts
- Medical and Healthcare Robotics, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ross Crawford
- Medical and Healthcare Robotics, Prince Charles Hospital, Queensland University of Technology, Brisbane, QLD, Australia
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Christiani Y, Dhippayom T, Chaiyakunapruk N. Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review. Glob Health Action 2016; 9:32505. [PMID: 27938647 PMCID: PMC5148807 DOI: 10.3402/gha.v9.32505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Inequalities 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. Objective To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs. Design We 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). Results Fifteen 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. Conclusions The 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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Affiliation(s)
- Yodi Christiani
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,CREDOS (Creative Development Strategies) Institute, Jakarta, Indonesia
| | - Teerapon Dhippayom
- Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,School of Pharmacy, University of Wisconsin, Madison, WI, USA.,School of Population Health, University of Queensland, Brisbane, QLD, Australia;
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11
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Webster E, Johnson C, Kemp B, Smith V, Johnson M, Townsend B. Theory that explains an Aboriginal perspective of learning to understand and manage diabetes. Aust N Z J Public Health 2016; 41:27-31. [PMID: 27868348 DOI: 10.1111/1753-6405.12605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/01/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To use grounded theory and participatory research methodology to explain how Aboriginal people learn to understand and manage type 2 diabetes. METHODS Aboriginal people with diabetes were invited to participate in one of five focus groups (n=25, male=12, female=13). Focus groups and education sessions were conducted by Aboriginal members of the research team. Focus groups were audio recorded and transcribed, with coding and first level analysis undertaken by all members of the research team. RESULTS Participants described colonisation and dislocation from Country and family members' experiences with diabetes as significant historical influences which, in conjunction with the model of care experienced and the type of interaction with health services, shaped how they came to understand and manage their diabetes. CONCLUSIONS Patient experience of a model of care alone is not what influences understanding and management of diabetes in Aboriginal people. Implications for Public Health: Health service improvements should focus on understanding past experiences of Aboriginal patients, improving interactions with health services and supporting holistic family centred models of care. Focusing on just the model of care in absence of other improvements is unlikely to deliver health benefits to Aboriginal people.
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Affiliation(s)
- Emma Webster
- School of Rural Health, University of Sydney, New South Wales
| | | | - Bernie Kemp
- Dubbo Regional Aboriginal Health Service, New South Wales
| | - Valerie Smith
- Dubbo Regional Aboriginal Health Service, New South Wales
| | | | - Billie Townsend
- School of Rural Health, University of Sydney, New South Wales
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