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Wiens K, Bai L, Hwang SW, Ronksley PE, Austin PC, Booth GL, Spackman E, Campbell DJT. Disparities in diabetes processes of care among people experiencing homelessness: An opportunity for intervention. Diabetes Res Clin Pract 2024; 213:111748. [PMID: 38885743 DOI: 10.1016/j.diabres.2024.111748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/23/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
AIMS To compare processes of diabetes care by homeless status. METHODS A population-based propensity matched cohort study was conducted in Ontario, Canada. People with diabetes were identified in administrative healthcare data between April 2006 and March 2019. Those with a documented history of homelessness were matched to non-homeless controls. Data on processes of care measures included glucose monitoring tests, screening for microvascular complications, and physician follow-up. Differences in processes of care were compared by homeless status using proportions, risk ratios, and rate ratios. RESULTS Of the 1,076,437 people with diabetes, 5219 matched pairs were identified. Homelessness was associated with fewer tests for glycated hemoglobin (RR = 0.63; 95 %CI: 0.60-0.67), LDL cholesterol (RR = 0.80; 95 %CI: 0.78-0.82), serum creatinine (RR = 0.94; 95 %CI: 0.92-0.97), urine protein quantification (RR = 0.62; 95 %CI: 0.59-0.66), and eye examinations (RR = 0.74; 95 %CI: 0.71-0.77). People with a history of homelessness were less likely to use primary care for diabetes management (RR = 0.62; 95 %CI: 0.59-0.66) or specialist care (RR = 0.87; 95 %CI: 0.83-0.91) compared to non-homeless controls. CONCLUSIONS Disparities in diabetes care are evident for people with a history of homelessness and contribute to excess morbidity in this population. These data provide an impetus for investment in tailored interventions to improve healthcare equity and prevent long-term complications.
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Affiliation(s)
- Kathryn Wiens
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Li Bai
- ICES Central, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
| | - Stephen W Hwang
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada; ICES Central, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada.
| | - Peter C Austin
- ICES Central, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
| | - Gillian L Booth
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada; ICES Central, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada.
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB T2N 4N1, Canada.
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Mercado M, Law L, Ferguson-Colvin K, Wolfersteig W. Intersectional Structural Stigma: A Qualitative Study With Persons Experiencing Homelessness in the Southwest United States. QUALITATIVE HEALTH RESEARCH 2024:10497323241239209. [PMID: 38902919 DOI: 10.1177/10497323241239209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12-17), young adults (ages 18-24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups (n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers.
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Affiliation(s)
- Micaela Mercado
- School of Social Work, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | - Lara Law
- School of Social Work, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | | | - Wendy Wolfersteig
- School of Social Work, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
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Reed T, Scott S, Grewal E, Macavinta F, Tariq S, Campbell DJT. Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness. Can J Diabetes 2024:S1499-2671(24)00066-2. [PMID: 38582226 DOI: 10.1016/j.jcjd.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES The rising prevalence of type 2 diabetes (T2D) in Canada poses a significant health challenge. Despite the convenience of screening for diabetes with glycated hemoglobin concentration, people experiencing homelessness (PEH) often face barriers to accessing diabetes screening, potentially leading to underdiagnosis. In this study, we aim to assess the prevalence of undiagnosed diabetes among PEH in Calgary, Alberta, and contribute insights for planning healthcare services and public health initiatives. METHODS Four screening clinics were held, and participants were recruited through posters and word of mouth. Participants underwent point-of-care glycated hemoglobin (A1C) testing using the Siemens DCA Vantage point-of-care analyzer. Descriptive statistics were used to identify the proportions of prediabetes and diabetes, whereas CanRisk survey scores were used to identify the pre-test probability of diabetes. RESULTS The mean age of participants (n=102) was 47.6 years, and the self-reported causes of homelessness among the participants were diverse, including: housing and financial issues (n=53), interpersonal and family issues (n=35), and health or corrections-related factors (n=27). The average A1C was 5.60% (standard deviation 0.57%), with 5 values in the diabetes range and 12 in the prediabetes range, for a total of 17 participants found to have previously undiagnosed dysglycemia. CONCLUSIONS The high rate of undiagnosed prediabetes and diabetes among people experiencing homelessness reflects at least what is already seen in the general population in Canada. More resources are required to reduce the barriers to screening for diabetes among this population.
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Affiliation(s)
- Tucker Reed
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sara Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eshleen Grewal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fatima Macavinta
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Drop-In Centre, Calgary, Alberta, Canada
| | - Saania Tariq
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Eseadi C, Amedu AN, Aloh HE. Significance of fostering the mental health of patients with diabetes through critical time intervention. World J Clin Cases 2023; 11:8486-8497. [PMID: 38188207 PMCID: PMC10768517 DOI: 10.12998/wjcc.v11.i36.8486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Critical time intervention (CTI) is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period. AIM To examine the significance of fostering the mental health of diabetes patients through CTI using the scoping review methodology. METHODS As part of the scoping review process, we followed the guidelines established by the Joanna Briggs Institute. The search databases were Google Scholar, PubMed, Scopus, PsycINFO, Reference Citation Analysis (https://www.referencecitationanalysis.com/), and Cochrane Library. From these databases, 77 articles were retrieved with the aid of carefully selected search terms. However, 19 studies were selected after two reviewers appraised the full texts to ensure that they are all eligible for inclusion, while 54 papers were excluded. RESULTS This study revealed that diabetic patients who had experienced homelessness were at higher risk of being diagnosed with mental illness and that social support services are impactful in the management of the comorbidity of diabetes and mental health problems. In addition, this review reveals that CTI is impactful in enhancing the mental health of homeless patients during the transitional period from the hospital through social support services. CONCLUSION CTI is a promising intervention for alleviating mental health symptoms in homeless patients. Empirical studies are needed across the globe, involving both hospitalized and community-based patients, to determine how clinically effectively CTI is in managing the mental health of diabetics.
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Affiliation(s)
- Chiedu Eseadi
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| | - Amos Nnaemeka Amedu
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| | - Henry Egi Aloh
- Department of Health Services, Alex Ekwueme Federal University, Ndufu-Alike Ikwo 482131, Ebonyi State, Nigeria
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Pine A. Ambient struggling: food, chronic disease, and spatial isolation among the urban poor. AGRICULTURE AND HUMAN VALUES 2022; 40:1-12. [PMID: 36575656 PMCID: PMC9780096 DOI: 10.1007/s10460-022-10408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
This paper uses the survival strategies of food shelf clients to explore how food access, chronic disease, and spatial isolation shape the lives of low- and no- income urban citizens. The abundant availability of unhealthy food intersects with the presence of long-term health conditions to create a marginalized urban space where low quality commodity food is available, but exacerbates existing health conditions, is difficult to access, and does little to create food security. To survive, clients have normalized a sustenance strategy of going to multiple food serving sites, carrying food long-distances and using SNAP benefits to make ends meet. However, this nourishment strategy is time-consuming and unsafe, demanding that people put themselves in precarious positions and push their bodies farther physically than is healthy. These food procurement strategies exacerbate their marginalization. Qualitative data from food shelf users is used to develop a theory of ambient struggling wherein the struggle for food access is unhealthy and time-consuming, making it difficult to improve their standard of living.
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Affiliation(s)
- Adam Pine
- Department of Geography and Philosophy, University of Minnesota Duluth, 324 Cina Hall. 1123 University Drive, Duluth, Minnesota 55812 USA
- University of Minnesota Duluth, 324 Cina Hall, 1024 University Drive, Duluth, Minnesota 55812 USA
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Easton C, Oudshoorn A, Smith-Carrier T, Forchuk C, Marshall CA. The experience of food insecurity during and following homelessness in high-income countries: A systematic review and meta-aggregation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3384-e3405. [PMID: 35869792 DOI: 10.1111/hsc.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Homelessness is a pervasive challenge caused by poverty which continues to grow in economically developed countries, posing significant health impacts (Fazel et al., Lancet, 384: 1529-1540, 2014). While food security related to poverty and low income has been investigated, this review specifically explores the experience of food security during and following homelessness. Given the fact that the health of individuals who experience homelessness is known to be poor and the importance of nutrition, this is a necessary contribution. Informed by a health equity lens, this review synthesises the findings and quality of the literature regarding experiences of food security during and following homelessness in high-income countries. We used the Joanna Briggs Institute methodology, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Qualitative studies published to date were obtained from six databases. We conducted a meta-aggregation of existing qualitative findings. Twenty-four studies on 462 participants were included in the review. Through meta-aggregation four themes were created: (1) imposed food options as a determinant of health out of my control; (2) obtaining food for survival despite stigma or other consequences; (3) situated within a system that maintains food insecurity; and (4) surviving hardships. Persons during and following homelessness in high-income countries face multiple challenges when securing food while situated in an oppressive system that lacks choice. Despite this, persons who have experienced homelessness demonstrate resilience by finding ways to meet their basic needs in the face of imposed barriers. Implications for research, policy and practice are offered.
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Affiliation(s)
- Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
| | - Tracy Smith-Carrier
- School of Humanitarian Studies, Royal Roads University, Victoria, British Columbia, Canada
| | - Cheryl Forchuk
- School of Nursing, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Asgary R, Beideck E, Naderi R. Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study. EClinicalMedicine 2022; 48:101418. [PMID: 35516444 PMCID: PMC9062666 DOI: 10.1016/j.eclinm.2022.101418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a dearth of data regarding diabetes control among patients experiencing homelessness. METHODS We retrospectively collected type 2 diabetes-related measurements, sociodemographic, and clinical indicators from medical records of all incoming adults with diabetes (n = 418; homeless: 356 and domiciled: 58) seen in shelter-clinics in New York City in 2019. The outcomes were the rates of inadequately managed diabetes and associated factors. FINDINGS Bivariate analysis showed that patients experiencing homelessness (63% Black; 32% Hispanic) 134/304 (43⋅9%) were more likely than domiciled patients 13/57 (22·8%) to have inadequately managed diabetes (OR 2⋅67, CI 1·38-5·16, p = 0⋅003). The average HbA1c among homeless (8·4%, SD± 2·6) was higher than that of domiciled persons (7·3%, SD± 1·8, p = 0·002). In logistic regression, domiciled status (OR 0⋅ 42, CI 0·21 - 0·84, p = 0·013), older age (OR 0·97, CI 0·95 - 0·99, p = 0·004), and non-Hispanic/Latino ethnicity were associated with well-managed diabetes. Among persons experiencing homelessness, non-Hispanic/Latino (OR 0·61, CI 0·37-0·99, p = 0·047) and older age (0·96, CI 0·94-0·99, p = 0·003) were associated with well-managed diabetes. In linear regression, mental illness (-0·11, p = 0·048) and older age (-0·15, p = 0·010) were associated with lower HbA1c, suggesting better support in respective shelters. There was no statistically significant association between inadequately managed diabetes with several traditional risk factors including substance or alcohol use disorder, health insurance, or other chronic diseases. INTERPRETATION Interventions at shelters or shelter-clinics should target subgroups in addition to addressing traditional risk factors to improve diabetes control. mHealth strategies could be considered to improve engagement, care delivery, and medication taking. Ultimately, homelessness itself needs to be addressed. FUNDING There are no funding sources to declare.
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Key Words
- BMI, body mass index
- BP, blood pressure
- CAD, coronary artery disease
- CKD, chronic kidney disease
- DM, diabetes mellitus
- Diabetes mellitus
- GFR, glomerular filtration rate
- HTN, hypertension
- HbA1c, hemoglobin A1c
- Health disparities
- Homeless
- LDL, low density lipoprotein
- PCP, primary care physician
- Primary care
- Quality care
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Affiliation(s)
- Ramin Asgary
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA
- Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA
- Corresponding author.
| | - Elena Beideck
- Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA
| | - Rosanna Naderi
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA
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Campbell RB, Larsen M, DiGiandomenico A, Davidson MA, Booth GL, Hwang SW, McBrien KA, Campbell DJT. Les défis de la gestion du diabète chez les personnes itinérantes : étude qualitative avec la méthode photovoix. CMAJ 2021; 193:E1184-E1192. [PMID: 34344778 PMCID: PMC8354642 DOI: 10.1503/cmaj.202537-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/03/2022] Open
Abstract
CONTEXTE: La recherche sur les défis de la prise en charge du diabète chez les personnes itinérantes qui en sont atteintes n’a pas tendance à prendre en considération le point de vue des personnes touchées. Nous avons utilisé une approche de recherche participative avec la communauté pour explorer ces défis. MÉTHODES: Nous avons recruté des cochercheurs ayant une connaissance expérientielle de l’itinérance et du diabète. Les chercheurs principaux leur ont offert une formation en recherche et ont préparé le terrain avec eux pour ce projet. Les cochercheurs ont collectivement choisi d’utiliser la méthode photovoix pour illustrer la difficulté de bien s’alimenter quand on est en situation d’itinérance et explorer en quoi cet écueil affecte plus largement la gestion du diabète. Après une formation en photographie et en éthique, les cochercheurs ont pris des photos en lien avec les objectifs du projet et rédigé des récits connexes au moyen de techniques de rédaction inspirée par des photos. Les chercheurs principaux ont analysé les photos et les récits, et ils en ont dégagé des thèmes qui se sont précisés lors de discussions de groupe. RÉSULTATS: Les 8 cochercheurs étaient atteints de diabète de type 2 (diagnostiqué de 18 mois à 23 ans auparavant) et avaient vécu en situation d’itinérance pendant des périodes allant de 8 mois à 12 ans. Nous avons dégagé 4 thèmes à partir de 17 photos et récits produits. L’itinérance affecte grandement la santé émotionnelle et mentale des personnes, ce qui nuit à leur capacité de bien gérer leur diabète. Les aliments servis dans les refuges sont rarement nutritifs ou appétissants. L’obtention d’une forme de logement peut faciliter la prise en charge du diabète en créant un environnement stable qui favorise l’autonomie, mais les coûts et le manque de connaissances sont des obstacles à la préparation de repas sains. L’itinérance complique aussi l’accès aux professionnels de la prise en charge du diabète et aux médicaments d’ordonnance. INTERPRÉTATION: Les images et les récits associés permettent de dresser un tableau frappant, complet et fidèle des défis auxquels sont confrontées les personnes en situation d’itinérance qui essaient de gérer leur diabète. Comprendre ces défis est la première étape qui permettra aux intervenants et aux décideurs de répondre aux besoins de cette population.
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Affiliation(s)
- Rachel B Campbell
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Matthew Larsen
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Anna DiGiandomenico
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Marleane A Davidson
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Gillian L Booth
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Stephen W Hwang
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Kerry A McBrien
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - David J T Campbell
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.
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10
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Grewal EK, Campbell RB, Booth GL, McBrien KA, Hwang SW, O’Campo P, Campbell DJT. Using concept mapping to prioritize barriers to diabetes care and self-management for those who experience homelessness. Int J Equity Health 2021; 20:158. [PMID: 34243783 PMCID: PMC8272311 DOI: 10.1186/s12939-021-01494-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diabetes is a chronic medical condition which demands that patients engage in self-management to achieve optimal glycemic control and avoid severe complications. Individuals who have diabetes and are experiencing homelessness are more likely to have chronic hyperglycemia and adverse outcomes. Our objective was to collaborate with individuals experiencing homelessness and care providers to understand the barriers they face in managing diabetes, as a first step in identifying solutions for enhancing diabetes management in this population. METHODS We recruited individuals with lived experience of homelessness and diabetes (i.e. clients; n = 32) from Toronto and health and social care providers working in the areas of diabetes and/or homelessness (i.e. providers; n = 96) from across Canada. We used concept mapping, a participatory research method, to engage participants in brainstorming barriers to diabetes management, which were subsequently categorized into clusters, using the Concept Systems Global MAX software, and rated based on their perceived impact on diabetes management. The ratings were standardized for each participant group, and the average cluster ratings for the clients and providers were compared using t-tests. RESULTS The brainstorming identified 43 unique barriers to diabetes management. The clients' map featured 9 clusters of barriers: Challenges to getting healthy food, Inadequate income, Navigating services, Not having a place of your own, Relationships with professionals, Diabetes education, Emotional wellbeing, Competing priorities, and Weather-related issues. The providers' map had 7 clusters: Access to healthy food, Dietary choices in the context of homelessness, Limited finances, Lack of stable, private housing, Navigating the health and social sectors, Emotional distress and competing priorities, and Mental health and addictions. The highest-rated clusters were Challenges to getting healthy food (clients) and Mental health and addictions (providers). Challenges to getting healthy food was rated significantly higher by clients (p = 0.01) and Competing priorities was rated significantly higher by providers (p = 0.03). CONCLUSIONS Experiencing homelessness poses numerous barriers to managing diabetes, the greatest of which according to clients, is challenges to getting healthy food. This study showed that the way clients and providers perceive these barriers differs considerably, which highlights the importance of including clients' insights when assessing needs and designing effective solutions.
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Affiliation(s)
- Eshleen K. Grewal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rachel B. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gillian L. Booth
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Kerry A. McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Stephen W. Hwang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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Sakai-Bizmark R, Mena LA, Estevez D, Webber EJ, Marr EH, Bedel LEM, Yee JK. Health Care Utilization of Homeless Minors With Diabetes in New York State From 2009 to 2014. Diabetes Care 2020; 43:2082-2089. [PMID: 32616618 PMCID: PMC7646203 DOI: 10.2337/dc19-2219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aims to describe differences in health care utilization between homeless and nonhomeless minors with diabetes. RESEARCH DESIGN AND METHODS Data from the Healthcare Cost and Utilization Project's Statewide Inpatient Database from New York for years 2009-2014 were examined to identify pediatric patients <18 years old with diabetes. Outcomes of interest included hospitalization rate, in-hospital mortality, admission through the emergency department (ED), diabetic ketoacidosis (DKA), hospitalization cost, and length of stay (LOS). Other variables of interest included age-group, race/ethnicity, insurance type, and year. Multivariate logistic regression models were used for in-hospital mortality, admission through ED, and DKA. Log-transformed linear regression models were used for hospitalization cost, and negative binomial regression models were used for LOS. RESULTS A total of 643 homeless and 10,559 nonhomeless patients were identified. The hospitalization rate was higher among homeless minors, with 3.64 per 1,000 homeless population compared with 0.38 per 1,000 in the nonhomeless population. A statistically significant higher readmission rate was detected among homeless minors (20.4% among homeless and 14.1% among nonhomeless, P < 0.01). Lower rates of DKA (odds ratio 0.75, P = 0.02), lower hospitalization costs (point estimate 0.88, P < 0.01), and longer LOS (incidence rate ratio 1.20, P < 0.01) were detected among homeless minors compared with nonhomeless minors. CONCLUSIONS This study found that among minors with diabetes, those who are homeless experience a higher hospitalization rate than the nonhomeless. Housing instability, among other environmental factors, may be targeted for intervention to improve health outcomes.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation, Torrance, CA .,Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Eliza J Webber
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | | | - Jennifer K Yee
- The Lundquist Institute for Biomedical Innovation, Torrance, CA.,Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA
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12
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Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study. J Christ Nurs 2019; 36:228-235. [PMID: 31490877 DOI: 10.1097/cnj.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.
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13
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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14
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Hadenfeldt C, Knezevich E, Black S. Diabetes Risk Assessment, A1C Measurement, and Goal Achievement of Standards of Care in Adults Experiencing Homelessness. DIABETES EDUCATOR 2019; 45:295-301. [DOI: 10.1177/0145721719843680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to explore diabetes in adults experiencing homelessness by evaluating diabetes risk, A1C measurement, and achievement of the goals of the American Diabetes Association (ADA) Standards of Medical Care in Diabetes. Methods Project Homeless Connect Omaha is a 1-day health and social services event for adults who are homeless. The event seeks to meet immediate needs, identify potential future needs, and provide a connection with community resources for further follow-up for these adults. Health professions students and faculty from the university where the event is held volunteer their time to provide these services. Risk assessment for type 2 diabetes, A1C measurement, and evaluation of the ADA Standards of Medical Care were available for participants of this event. Results Of the 478 participants who completed a risk assessment for diabetes, 91 underwent rapid A1C testing. Four participants at the diabetes station (4%) were newly identified as having diabetes with elevated A1C, and 32% of the participants had elevated A1C levels demonstrating prediabetes. Twelve individuals reported being previously diagnosed with diabetes, and of those, 50% had A1C levels between 7.3% and >13% (56 to 119 mmol/mol). Participants whose A1Cs classified them as having prediabetes or diabetes (n = 40) completed an evaluation of standards of medical care goals. Participants identified eye, foot, and dental examinations; lipid management; and urine protein screening as some of the areas in which the standards were not yet achieved. Conclusion Adults experiencing homelessness have a significant need for diabetes screening and management. Diabetes educators can provide education to equip adults with the ability to effectively manage their illness and prevent complications.
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Affiliation(s)
| | - Emily Knezevich
- School of Pharmacy and Health Professions, Department of Pharmacy Practice, Creighton University, Omaha, Nebraska
| | - Susannah Black
- College of Nursing, Creighton University, Omaha, Nebraska
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15
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Roche M, Duffield C, Smith J, Kelly D, Cook R, Bichel-Findlay J, Saunders C, Carter D. Nurse-led primary health care for homeless men: a multimethods descriptive study. Int Nurs Rev 2017; 65:392-399. [DOI: 10.1111/inr.12419] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M.A. Roche
- Mental Health Drug and Alcohol Nursing; Northern Sydney Local Health District & Australian Catholic University; Sydney NSW Australia
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - C. Duffield
- Nursing & Health Services Management; University of Technology Sydney; Sydney NSW Australia
- Nursing & Health Services Management; Edith Cowan University; Western Australia
| | - J. Smith
- Primary Health Clinic; Matthew Talbot Hostel; St Vincent de Paul Society New South Wales; Woolloomooloo NSW Australia
| | - D. Kelly
- Support Services; St Vincent de Paul Society New South Wales; Australia
| | - R. Cook
- Centre for Health Services Management; University of Technology Sydney; Sydney NSW Australia
| | - J. Bichel-Findlay
- Digital Health and Innovation; Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - C. Saunders
- Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - D.J. Carter
- Faculty of Law; University of Technology Sydney; Sydney NSW Australia
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16
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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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17
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Abstract
Populations experiencing homelessness with diabetes may encounter barriers to accessing comprehensive diabetes care to manage the condition, yet it is unclear to what extent this population is able to access care. We reviewed the literature to identify and describe the barriers and facilitators to accessing diabetes care and managing diabetes for homeless populations using the Equity of Access to Medical Care Framework. An integrated review of the literature was conducted and yielded 10 articles that met inclusion criteria. Integrated reviews search, summarize, and critique the state of the research evidence. Findings were organized using the dimensions of a comprehensive conceptual framework, the Equity of Access to Medical Care Framework, to identify barriers and facilitators to accessing care and managing diabetes. Barriers included competing priorities, limited access to healthy food, and inadequate healthcare resources. Facilitators to care included integrated delivery systems that provided both social and health-related services, and increased patient knowledge. Recommendations are provided for healthcare providers and public health practitioners to optimize diabetes outcomes for this population.
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Affiliation(s)
- Brandi M White
- Division of Healthcare Studies, College of Health Professions, Medical University of South Carolina, 151B Rutledge Avenue, MSC 962, Charleston, SC, 29425-1600, USA.
| | - Ayaba Logan
- Department of Library Science and Informatics, Medical University of South Carolina, 171 Ashley Avenue, PO Box 250403, Charleston, SC, 29425-1600, USA
| | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St., MSC 160, Charleston, SC, 29425-1600, USA
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