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Woodward A, Walters K, Davies N, Nimmons D, Protheroe J, Chew‐Graham CA, Stevenson F, Armstrong M. Barriers and facilitators of self-management of diabetes amongst people experiencing socioeconomic deprivation: A systematic review and qualitative synthesis. Health Expect 2024; 27:e14070. [PMID: 38751247 PMCID: PMC11096776 DOI: 10.1111/hex.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The number of people living with diabetes is rising worldwide and a higher prevalence of diabetes has been linked to those experiencing socioeconomic deprivation. Self-management strategies are vital and known to reduce the risks of long-term complications amongst people living with diabetes. Lack of knowledge about self-care activity required to manage diabetes is a key barrier to successful self-management. Self-management interventions can be less effective in socioeconomically deprived populations which can increase the risk of exacerbating health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management of diabetes amongst people who are socioeconomically disadvantaged. METHODS MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions amongst socioeconomically disadvantaged populations. Relevant papers which focused on diabetes were identified. Data were coded and thematically synthesised using NVivo. FINDINGS From the search results, 79 qualitative studies were identified after full-text screening and 26 studies were included in the final thematic analysis. Two overarching analytical themes were identified alongside a set of subthemes: (1) Socioeconomic barriers to diabetes self-management; healthcare costs, financial costs of healthy eating, cultural influences, living in areas of deprivation, competing priorities and time constraints, health literacy, (2) facilitators of diabetes self-management; lifestyle and having goals, support from healthcare providers, informal support. DISCUSSION Self-management of diabetes is challenging for people experiencing socioeconomic deprivation due to barriers associated with living in areas of deprivation and financial barriers surrounding healthcare, medication and healthy food. Support from healthcare providers can facilitate self-management, and it is important that people with diabetes have access to interventions that are designed to be inclusive from a cultural perspective as well as affordable. PATIENT OR PUBLIC CONTRIBUTION A patient advisory group contributed to the research questions and interpretation of the qualitative findings by reflecting on the themes developed.
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Affiliation(s)
- Abi Woodward
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Nathan Davies
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Danielle Nimmons
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | | | - Fiona Stevenson
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Megan Armstrong
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
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Ferdous J, Uddin MH, Mahmud R, Hennessey M, Al Sattar A, Das Gupta S, Gibson JS, Alders R, Henning J, Fournié G, Hoque MA. Mapping of dressed and processed poultry products in Bangladesh: Identifying the food safety risks for policy intervention. Vet Res Commun 2023; 47:1991-2002. [PMID: 37369943 DOI: 10.1007/s11259-023-10153-7] [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: 03/03/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Bangladesh's commercial poultry production is growing rapidly, including the commercial processing of poultry. This expansion of poultry processing plants is fueled by the belief that this sub-sector provides safer food and has less food-borne disease risks compared to traditional live bird markets (LBMs). The purpose of this study is to describe Bangladesh's dressed and processed poultry production and distribution network (PDN), identify what and where quality control occurs, and suggest where improvements could be made. Engaging with PDN for dressed and processed poultry, we used in-depth interviews with key informants to identify the stakeholders involved and their connections with other poultry PDNs. In addition, we mapped out the supply and distribution of dressed and processed poultry and quality control processes occurring throughout the network. We argue that dressed and processed poultry PDNs are closely connected with traditional PDNs such as LBMs, with multiple crossover points between them. Also, there is a lack of consistency in quality control testing and a lack of meat traceability. Consequently, perceptions of dressed and processed poultry being safer than birds from LBMs needs to be treated with caution. Otherwise, unsubstantiated consumer confidence in dressed poultry may inadvertently increase the risk of food-borne diseases from these products.
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Affiliation(s)
- Jinnat Ferdous
- School of Veterinary Science, The University of Queensland, Queensland, Australia.
| | - Md Helal Uddin
- Chattogram Veterinary and Animal Sciences University, Chittagong, Bangladesh
| | - Rashed Mahmud
- Chattogram Veterinary and Animal Sciences University, Chittagong, Bangladesh
| | - Mathew Hennessey
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, UK
| | - Abdullah Al Sattar
- Chattogram Veterinary and Animal Sciences University, Chittagong, Bangladesh
| | - Suman Das Gupta
- School of Veterinary Science, The University of Queensland, Queensland, Australia
- Gulbali Institute, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Justine S Gibson
- School of Veterinary Science, The University of Queensland, Queensland, Australia
| | - Robyn Alders
- Development Policy Centre, Australian National University, Canberra, NSW, Australia
- Global Health Program, Chatham House, London, UK
| | - Joerg Henning
- School of Veterinary Science, The University of Queensland, Queensland, Australia
| | - Guillaume Fournié
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, UK
- INRAE, VetAgro Sup, UMR EPIA, Université de Lyon, Marcy l'Etoile, 69280, France
- INRAE, VetAgro Sup, UMR EPIA, Université Clermont Auvergne, Saint Genes Champanelle, 63122, France
| | - Md Ahasanul Hoque
- Chattogram Veterinary and Animal Sciences University, Chittagong, Bangladesh
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Nebhinani M, Avasthi RD, Meena M, Parihar M, Sharma M, Nagar M, Neha, Nisha. Barriers related to self-care management among people with diabetes mellitus- A narrative review. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictions, lifestyle and behavioural modifications. Self-care management behaviors are very much essential to control glycaemic values and future complications. Although an import aspect leading to positive health outcomes among diabetic patients, diabetes self-care management is usually is a complex process. This narrative review summates barriers related to self-care management among people with diabetes. The literature was searched through databases like PubMed and google scholar with help of keywords and MeSH terminologies. Furthermore, selected articles reference list was also screened. It is concluded that self-care management in diabetes mellitus is often surrounded by many barriers. Deficiency of environmental resources and assisted strategies, poor awareness regarding self-care skills, lack of motivation and financial constraints are the major barriers faced by people with diabetes mellitus. Endeavour to withdraw barriers are prime in aiding people living with diabetes which will help to improve their quality of life and to attain positive results.
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Chittooru CS, Gorantla Ananda K, Panati DD, Chaudhuri S, Prahalad H. Self-care practices and its determinants among diabetic population in rural Andhra Pradesh, India: A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Liese AD, Davis RE, Diaz D, Stucker J, Reid LA, Jindal M, Stancil M, Jones SJ. Experiences of Food Insecurity and Type 2 Diabetes Management in Adults. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2020.1826380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rachel E. Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Diana Diaz
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica Stucker
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Lauren A. Reid
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Meenu Jindal
- Department of Internal Medicine, Prisma Health Upstate, Greenville, SC, USA
| | - Michelle Stancil
- Department of Diabetes Management, Prisma Health Upstate, Greenville
| | - Sonya J. Jones
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Walker RJ, Walker RE, Mosley-Johnson E, Egede LE. Exploring the Lived Experience of Food Insecure African Americans with Type 2 Diabetes Living in the Inner City. Ethn Dis 2021; 31:527-536. [PMID: 34720556 PMCID: PMC8545483 DOI: 10.18865/ed.31.4.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Despite evidence that food insecure African Americans with type 2 diabetes are at particularly high risk for poor health outcomes, there is currently a lack of information on their lived experience. This qualitative study aimed to identify challenges, facilitators, and barriers to effective diabetes care for food insecure African Americans with type 2 diabetes residing in an inner city. Methods In fall 2018, we conducted two focus groups attended by a total of 16 food insecure adults with type 2 diabetes residing in the inner city of Milwaukee, Wisconsin. A standardized moderator guide included questions to explore the role of food insecurity in managing diabetes, and facilitators that improve diabetes management within the context of food insecurity. Focus groups were audio recorded and recordings were transcribed by a professional transcription service. A grounded theory approach was used for analysis. Results Six major challenges existed at the individual level (diet/nutrition, exercise, diabetes knowledge and skills, complications from diabetes, a family history of diabetes, and a preoccupation with food). Five major barriers and facilitators existed both internally and externally to the individuals (access to food, medications, stress, cost of health-related needs and religion/spirituality). Conclusions This study identified multiple challenges, barriers, and facilitators to effective care for food insecure African American adults with type 2 diabetes. It is imperative to incorporate this understanding in future work by using an ecological approach to investigate strategies to address food insecurity beyond a singular focus on access to food.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Renee E Walker
- Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI
| | - Elise Mosley-Johnson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Jefferies K, Richards T, Blinn N, Sim M, Kirk SFL, Dhami G, Helwig M, Iduye D, Moody E, Macdonald M, Tomblin Murphy G, Martin-Misener R. Food security in African Canadian communities: a scoping review. JBI Evid Synth 2021; 20:37-59. [PMID: 34149022 DOI: 10.11124/jbies-20-00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to chart the evidence relating to food security among African Canadian communities to inform future research and offer insight related to food security in African Canadian communities. INTRODUCTION Achieving food security is of global importance in the attainment of the United Nations Sustainable Development Goals. As a social determinant of health, food security, which refers to the unrestricted physical, economic, and timely access to safe and nutritious foods, impacts over four million Canadians. Yet, little is known about food security and the differential impacts of food insecurity among African Canadians. This scoping review sought to describe the current state of food security among African Canadians. INCLUSION CRITERIA Sources were considered for inclusion if they met the eligibility criteria outlined in the a priori protocol. Specifically, sources were considered if they: i) focused on Canada, ii) involved African Canadians, and iii) examined food security. No restrictions were placed on date of publication and language restrictions were limited to English and French. METHODS This scoping review was conducted in accordance with JBI methodology and comprised a search of published and unpublished sources. Data were extracted independently in Excel by two team members according to data items outlined in the extraction tool. In instances where articles were unavailable, authors of potential sources were contacted at the full-text review phase to request access to the full text of their article. Databases and relevant websites containing peer-reviewed, unpublished, and gray literature were searched. Ancestry searching and forward citation tracing were completed. RESULTS The search of databases yielded a total of 1183 records. Ancestry tracing yielded 287 records. After removing duplicates, 1075 titles and abstracts were screened for eligibility and 80 advanced to full-text screening. Seventy-five full-text articles were excluded based on inclusion criteria, leaving five articles that underwent data extraction. All included studies involved African Canadian participants in Canada (n = 5). All studies focused on adults (n = 5); one study included women and men participants (n = 1), while four focused exclusively on women (n = 4). Importantly, one study involving women participants included cis- and trans women as well as those identifying as queer (n = 1). Study designs reflected qualitative (n = 2), quantitative (n = 1), and mixed methods (n = 2) designs. CONCLUSIONS This review begins to fill a gap in understanding the current evidence available on food security as it impacts African Canadians. The findings of this review represent existing research, describing the type of evidence available and methodologies used, before suggesting implications for research and practice. The inclusion of only five studies reveals the limited evidence regarding the current state of food security among African Canadians. Further, included studies were exclusively conducted in urban settings; predominantly in one province. There is a need for further research in rural communities, in other provinces and territories, as well as with younger and older participants. Lastly, the urgent need to collect race-disaggregated data in Canada is evident.
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Affiliation(s)
- Keisha Jefferies
- School of Nursing, Dalhousie University, Halifax, NS, Canada Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada Nova Scotia Health, Halifax, NS, Canada Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada WK Kellogg Library, Dalhousie University, Halifax, NS, Canada
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Food insecurity and housing affordability among low-income families: does housing assistance reduce food insecurity? Public Health Nutr 2021; 24:4339-4345. [PMID: 33663635 DOI: 10.1017/s1368980021001002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the competing needs for food and housing under the limited household income among poor families, there is lack of research on the associations between housing affordability and food insecurity. The current study examines how housing cost burden affects food insecurity of low-income families and whether decreased housing cost enhances food security. DESIGN Longitudinal data from the Korean Welfare Panel Study, of which the final sample for the analysis consisted of 31 304 household-level observations from 5466 households based on twelve waves (2007-2018). SETTING South Korea. PARTICIPANTS Low-income households in the lowest 40 % of household income distribution. RESULTS 19·3 % had food insecurity, and housing cost burden was associated with food insecurity. While in-kind housing assistance and in-cash assistance from all sources were likely to reduce food insecurity partially through influencing housing cost burden, in-cash housing assistance was associated with higher likelihood of food insecurity. CONCLUSIONS Housing cost burden potentially limits food access among poor families, and housing assistance, particularly public housing and sufficient in-cash assistance, is conducive to alleviating food insecurity.
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Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Ferré-Eguiluz I, Flores D, Gaitán-Rossi P, Teruel G, Pérez-Escamilla R. Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review. Int J Equity Health 2021; 20:40. [PMID: 33472636 PMCID: PMC7816472 DOI: 10.1186/s12939-020-01330-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this "urban advantage" does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition. OBJECTIVES This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.'s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis. RESULTS Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition. CONCLUSIONS This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the "urban advantage". A conceptual framework emerging from the existing literature is proposed to guide future studies and policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO Registration number: CRD42018089788 .
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Affiliation(s)
- Mireya Vilar-Compte
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico.
| | - Soraya Burrola-Méndez
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Annel Lozano-Marrufo
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Isabel Ferré-Eguiluz
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Diana Flores
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Pablo Gaitán-Rossi
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Graciela Teruel
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
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Chater AM, Smith L, Ferrandino L, Wyld K, Bailey DP. Health behaviour change considerations for weight loss and type 2 diabetes: nutrition, physical activity and sedentary behaviour. PRACTICAL DIABETES 2020. [DOI: 10.1002/pdi.2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Angel Marie Chater
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
- Centre for Behavioural Medicine, University College London UK
| | - Lindsey Smith
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
| | - Louise Ferrandino
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
| | - Kev Wyld
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, Faculty of Education and Sport, University of Bedfordshire Bedford UK
| | - Daniel P Bailey
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London Uxbridge UK
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London Uxbridge UK
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Lowering the impact of food insecurity in African American adults with type 2 diabetes mellitus (LIFT-DM) - Study protocol for a randomized controlled trial. Contemp Clin Trials 2020; 99:106206. [PMID: 33166622 PMCID: PMC7726093 DOI: 10.1016/j.cct.2020.106206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is strong evidence that disparities in the burden of diabetes exist by both race and poverty. Food insecurity, or an inability to or limitation in accessing nutritionally adequate food, is an important modifiable social determinant of health, particularly in adults with chronic disease. African Americans are more likely to be diagnosed with diabetes and more likely than whites to be food insecure. METHODS We describe a 4-year ongoing randomized controlled trial, which will test the separate and combined efficacy of monthly food vouchers and monthly food stock boxes layered upon diabetes education in improving glycemic control in low income, food insecure, African Americans with type 2 diabetes mellitus using a 2 × 2 factorial design. Three hundred African American adults with clinical diagnosis of diabetes and HbA1c ≥ 8% will be randomized into one of four groups: 1) diabetes education alone; 2) diabetes education plus food vouchers; 3) diabetes education plus stock boxes; and 4) diabetes education plus combined food vouchers and stock boxes. Our primary hypothesis is: among low-income, food insecure, African Americans with type 2 diabetes, those receiving diabetes education enhanced with food supplementation (food vouchers alone, stock boxes alone, or combination) will have significantly greater reduction in HbA1c at 12 months compared to those receiving diabetes education only. DISCUSSION Results from this study will yield valuable insight currently lacking on how best to design and deliver diabetes interventions to low-income, food insecure, African Americans with diabetes that takes into account both clinical and social determinants of health. TRIAL REGISTRATION This study was registered on November 29, 2019 with the United States National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT04181424).
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Blitstein JL, Lazar D, Gregory K, McLoughlin C, Rosul L, Rains C, Hellman T, Leruth C, Mejia J. Foods for Health: An Integrated Social Medical Approach to Food Insecurity Among Patients With Diabetes. Am J Health Promot 2020; 35:369-376. [PMID: 33043687 DOI: 10.1177/0890117120964144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Examine a clinic-based approach to improve food security and glycemic control among patients with diabetes. DESIGN One-group repeated-measures design. SETTING Federally Qualified Health Centers in a large Midwest city. SAMPLE Of the 933 patients with diabetes who consented at baseline, 398 (42.66%) returned during the follow-up period for a visit that included Hemoglobin A1c (HbA1c) results. INTERVENTION Integrated social medicine approach that includes food insecurity screening, nutrition education, and assistance accessing food resources as a standard-of-care practice designed to minimize disruptions in how patients and providers experience medical care. MEASURES HbA1c collected as part of a standard blood panel. ANALYSIS Repeated-measure, mixed-effect linear regression models. RESULTS There was a decrease in mean HbA1c (Δ = -0.22, P = 0.01) over the study period. The model examining change over time, glycemic control (GC), and food security status (F1, 352 = 5.80, P = 0.02) indicated that among participants with poor GC (33.12%), food secure (FS) participants exhibited significantly greater levels of improvement than food insecure (FI) participants (Δ = -0.55, P = 0.04). Among participants with good GC, changes in HbA1c were not significantly different between FS and FI participants (Δ = 0.23, P = 0.21). CONCLUSION Providing nutrition education and food assistance improved HbA1c profiles among FS and FI participants, but FI participants may face social and structural challenges that require additional support from health care teams.
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Affiliation(s)
| | | | | | | | - Linda Rosul
- 50733Access Community Health Network, Chicago, IL, USA
| | | | - Talya Hellman
- 50733Access Community Health Network, Chicago, IL, USA
| | | | - Jairo Mejia
- 50733Access Community Health Network, Chicago, IL, USA
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O'Donnell S. 'Your wealth is your health': the fundamental causes of inequalities in diabetes management outcomes: a qualitative analysis. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1626-1641. [PMID: 33460137 DOI: 10.1111/1467-9566.13156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fundamental Cause Theory (FCT) is among the most influential explanations for health inequalities. The theory posits that the social gradient in health persists because higher-socioeconomic status (SES) groups are systematically more able to take advantage of new medical innovations and health-enhancing knowledge due to their greater access to resources. Taking the life histories of people with diabetes (PwD) (N = 17) in the Republic of Ireland as a case study, this paper aims to elucidate the behaviours and agencies underlying 'fundamental causality' through examining how PwD of contrasting SES respond to disease management information. Findings highlight how the most common barriers to effective diabetes control were chronic psychological distress, combined with the cultural significance of alcohol consumption, which was central to both the social and economic subsistence of male participants in particular. However, higher-SES groups were more likely to experience a 'turnabout' in their life, whereby they could remove themselves from the conditions giving rise to their distress and move into a social space where more health-enhancing behaviours were possible. It concludes with a discussion of potential mechanisms that may explain why such turnabouts were more likely to occur in the case of higher-SES groups and the implications for FCT.
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Affiliation(s)
- Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
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Cox C, Alyahyawi N, Ornstein A, Cummings EA. Experience of Caring for a Child With Type 1 Diabetes Mellitus in a Food-Insecure Household: A Qualitative Evaluation. Can J Diabetes 2020; 45:64-70. [PMID: 32861605 DOI: 10.1016/j.jcjd.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES An earlier study from Nova Scotia showed that food insecurity (FI) is more prevalent (21.9%) in families of children with diabetes, yet little is known about its impact on these families. We aimed to describe the day-to-day experiences of families living with FI while caring for a child with type 1 diabetes (T1D). METHODS This investigation was a qualitative study with thematic analyses using semistructured interviews to explore perceptions of caregivers living with pediatric T1D and FI (N=13 households). RESULTS Three major themes emerged: 1) FI had a disproportionate impact on families after T1D diagnosis compared with before diagnosis. The cost of healthy food threatened food security before T1D; however, there is increased hardship once high-quality food and hypoglycemia supplies are required. 2) Sacrifices to combat FI have disproportionate impacts among family members. At times, caregivers sacrificed the needs (food, medicine) of other family members (including children) to prioritize the needs of the child with T1D. 3) Caregivers perceived T1D needs as posing unique barriers to traditional FI supports, such as school breakfast programs. CONCLUSIONS This study provides insight into the realities of life with pediatric T1D and FI. Living with T1D and FI poses challenges, and caregivers often cope by making difficult choices when providing for their family. Caregivers struggled to meet dietary recommendations while finding that T1D needs are often not met by traditional FI supports. This suggests that T1D clinicians should assess FI and help families in problem solving to mitigate its impact.
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Affiliation(s)
- Catherine Cox
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naseem Alyahyawi
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada; Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amy Ornstein
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Elizabeth A Cummings
- Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada.
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Flint KL, Davis GM, Umpierrez GE. Emerging trends and the clinical impact of food insecurity in patients with diabetes. J Diabetes 2020; 12:187-196. [PMID: 31596548 DOI: 10.1111/1753-0407.12992] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022] Open
Abstract
Food insecurity is a major public health concern in the United States affecting 15 million households according to data in 2017 from the US Department of Agriculture. Food insecurity, or the inability to consistently obtain nutritious food, disproportionately affects socioeconomically disadvantaged households, as well as those with chronic diseases including diabetes mellitus (DM). This review article explores the literature over the past 10 years pertaining to the complex relationship between food insecurity, social determinants of health, and chronic disease with an emphasis on diabetes and glycemic control. Those with diabetes and food insecurity together have been shown to have worse glycemic control compared to those who are food secure, but it remains unclear exactly how food insecurity affects glycemic control. Prior interventional studies have targeted aspects of food insecurity in patients with diabetes but have reported variable outcomes with respect to improvement in glycemic control despite effectively reducing rates of food insecurity. Additionally, few data exist regarding long-term outcomes and diabetes-related complications in this population. It is likely that many factors at both the community and individual levels impact glycemic control outcomes in the setting of food insecurity. Further studies are needed to better understand these factors and to create multifaceted targets for future interventional studies aimed at improving glycemic control in this population.
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16
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Combined effects of disease management and food insecurity on physical and mental health in Korean adults. Public Health Nutr 2019; 23:112-122. [PMID: 31744589 DOI: 10.1017/s1368980019003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present study aimed to examine the combined effects of disease management and food insecurity on physical and mental health in a representative Korean population. DESIGN A cross-sectional study. SETTING Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012-2015. PARTICIPANTS Adults aged ≥30 years (n 17 934) who participated in the KNHANES. RESULTS Among health-care factors, unmet health-care needs and mental health counselling were different by food insecurity status, with a higher prevalence in adults with food insecurity. The prevalence of underweight was higher in men with food insecurity (5·9 %), whereas the prevalence of obesity was higher in women with food insecurity (37·4 %), than that in men and women with food security. Food insecurity was associated with a high risk of all mental health outcomes. For the combined effects of disease management and food insecurity, unmet health-care needs was related to increased risk of obesity for food-insecure men (Pinteraction = 0·029) and lack of participation in nutrition education or counselling was related to increased risk of obesity for food-insecure women (Pinteraction = 0·010). In addition, higher unmet health-care needs in adults with food insecurity was related to higher risk of mental health outcomes. CONCLUSIONS Unmet health-care needs may exacerbate obesity for food-insecure men and mental health problems for both food-insecure men and women. In addition, lack of participation in nutrition education or counselling may exacerbate the obesity for food-insecure women.
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Gucciardi E, Yang A, Cohen-Olivenstein K, Parmentier B, Wegener J, Pais V. Emerging practices supporting diabetes self-management among food insecure adults and families: A scoping review. PLoS One 2019; 14:e0223998. [PMID: 31693702 PMCID: PMC6834117 DOI: 10.1371/journal.pone.0223998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/02/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Food insecurity undermines a patient's ability to follow diabetes self-management recommendations. Care providers need strategies to direct their support of diabetes management among food insecure patients and families. OBJECTIVE To identify what emerging practices health care providers can relay to patients or operationalize to best support diabetes self-management among food insecure adults and families. ELIGIBILITY CRITERIA Food insecure populations with diabetes (type 1, type 2, prediabetes, gestational diabetes) and provided diabetes management practices specifically for food insecure populations. Only studies in English were considered. In total, 21 articles were reviewed. SOURCES OF EVIDENCE Seven databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Medline, ProQuest Nursing & Allied Health Database, PsychInfo, Scopus, and Web of Science. RESULTS Emerging practices identified through this review include screening for food insecurity as a first step, followed by tailoring nutrition counseling, preventing hypoglycemia through managing medications, referring patients to professional and community resources, building supportive care provider-patient relationships, developing constructive coping strategies, and decreasing tobacco smoking. CONCLUSION Emerging practices identified in our review include screening for food insecurity, nutrition counselling, tailoring management plans through medication adjustments, referring to local resources, improving care provider-patient relationship, promoting healthy coping strategies, and decreasing tobacco use. These strategies can help care providers better support food insecure populations with diabetes. However, some strategies require further evaluation to enhance understanding of their benefits, particularly in food insecure individuals with gestational and prediabetes, as no studies were identified in these populations. A major limitation of this review is the lack of global representation considering no studies outside of North America satisfied our inclusion criteria, due in part to the English language restriction.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Adalia Yang
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Jessica Wegener
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Vanita Pais
- Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
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Vitale M, Dorado L, Pais V, Sidani S, Gucciardi E. Food Insecurity Screening Among Families of Children With Diabetes. Diabetes Spectr 2019; 32:338-348. [PMID: 31798292 PMCID: PMC6858075 DOI: 10.2337/ds18-0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Little is known about screening in clinical settings for food insecurity (FI) among households of children with diabetes. This study evaluated the acceptability and feasibility of an FI screening initiative in a pediatric diabetes clinic that was implemented to help diabetes dietitian educators tailor management plans for families of children with type 1 or type 2 diabetes facing FI. The initiative comprised three validated screening questions, a care algorithm, a community resource handout, and a poster. In total, 50 families of children and adolescents aged 0-18 years with type 1 or type 2 diabetes were screened for FI. In-person semi-structured interviews combining open-ended and Likert-scale questions were conducted with 37 of the screened families and the three diabetes dietitian educators who conducted the screening. Perceived barriers and facilitators of the screening initiative were identified using content analysis, and Likert-scale questionnaires rated interviewees' comfort level with the screening questions. A reflective journal kept by an onsite research interviewer also facilitated the data interpretation process. Most families felt comfortable answering the screening questions. Families with FI appreciated the opportunity to express their concerns and learn about affordable food resources. However, ∼20% of these families described stigma and fear of judgment by clinicians if they screened positive for FI. Diabetes educators also felt comfortable with the screening questions but reported lack of time to screen all families and to follow-up with resources after a positive screen. A self-reported intake form was recommended to ensure that everyone is systematically screened. A standardized and respectful method of assessing FI could help clinicians better tailor treatment plans and support for families of children with diabetes who face FI. Based on these findings, similar FI screening initiatives should be implemented in other clinical settings as part of routine clinical practice.
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Affiliation(s)
- Michele Vitale
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Souraya Sidani
- School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
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Wetherill MS, Williams MB, White KC, Seligman HK. Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support. DIABETES EDUCATOR 2019; 45:397-407. [PMID: 31204590 DOI: 10.1177/0145721719857547] [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 is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs. METHODS The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors. RESULTS Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened. CONCLUSION Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.
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Affiliation(s)
- Marianna S Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health and Department of Family and Community Medicine, OU-TU School of Community Medicine, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Mary B Williams
- Department of Biostatistics and Epidemiology, Hudson College of Public Health and Department of Family and Community Medicine, OU-TU School of Community Medicine, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Kayla C White
- Hudson College of Public Health, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Hilary K Seligman
- Department of Medicine, University of California San Francisco, San Francisco, California and Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
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Bergmans RS, Zivin K, Mezuk B. Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study. J Psychosom Res 2019; 117:22-29. [PMID: 30665592 PMCID: PMC6467465 DOI: 10.1016/j.jpsychores.2018.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes. METHODS Data came from the 2010-2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms. RESULTS Food insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 1.1-2.5) and diabetes-related kidney problems (OR = 1.6; 95% CI = 1.1-2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95% CI = 1.7-2.4) and longitudinally (OR = 1.5, 95% CI = 1.3-1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5% (p-value = .09) of the association with depressive symptoms in 2014. CONCLUSION The relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.
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Affiliation(s)
- Rachel S Bergmans
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States; Department of Veterans Affairs, Ann Arbor, MI, United States
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
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What can Secondary Data Tell Us about Household Food Insecurity in a High-Income Country Context? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010082. [PMID: 30597954 PMCID: PMC6338928 DOI: 10.3390/ijerph16010082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022]
Abstract
In the absence of routinely collected household food insecurity data, this study investigated what could be determined about the nature and prevalence of household food insecurity in Scotland from secondary data. Secondary analysis of the Living Costs and Food Survey (2007–2012) was conducted to calculate weekly food expenditure and its ratio to equivalised income for households below average income (HBAI) and above average income (non-HBAI). Diet Quality Index (DQI) scores were calculated for this survey and the Scottish Health Survey (SHeS, 2008 and 2012). Secondary data provided a partial picture of food insecurity prevalence in Scotland, and a limited picture of differences in diet quality. In 2012, HBAI spent significantly less in absolute terms per week on food and non-alcoholic drinks (£53.85) compared to non-HBAI (£86.73), but proportionately more of their income (29% and 15% respectively). Poorer households were less likely to achieve recommended fruit and vegetable intakes than were more affluent households. The mean DQI score (SHeS data) of HBAI fell between 2008 and 2012, and was significantly lower than the mean score for non-HBAI in 2012. Secondary data are insufficient to generate the robust and comprehensive picture needed to monitor the incidence and prevalence of food insecurity in Scotland.
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Pathways between food insecurity and glycaemic control in individuals with type 2 diabetes. Public Health Nutr 2018; 21:3237-3244. [PMID: 30088467 DOI: 10.1017/s1368980018001908] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Food insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.Design/Setting/SubjectsAdults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support. RESULTS The final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=-0·54, P<0·001) and lower social support (r=-0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control. CONCLUSIONS Food insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.
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Weaver LJ, Fasel CB. A Systematic Review of the Literature on the Relationships between Chronic Diseases and Food Insecurity. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/fns.2018.95040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Developing and Implementing a Food Insecurity Screening Initiative for Adult Patients Living With Type 2 Diabetes. Can J Diabetes 2017; 42:257-262. [PMID: 28797890 DOI: 10.1016/j.jcjd.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/13/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Routine food insecurity screening is recommended in diabetes care to inform more tailored interventions that better support diabetes self-management among food-insecure patients. This pilot study explored the acceptability and feasibility of a food insecurity screening initiative within a diabetes care setting in Toronto. METHODS A systematic literature review informed the development of a food insecurity screening initiative to help health-care providers tailor diabetes management plans and better support food-insecure patients with type 2 diabetes. Interviews with 10 patients and a focus group with 15 care providers elicited feedback on the relevance and acceptance of the food insecurity screening questions and a care algorithm. Subsequently, 5 care providers at 4 sites implemented the screening initiative over 2 weeks, screening 33 patients. After implementation, 7 patients and 5 care providers were interviewed to assess the acceptability and feasibility of the screening initiative. RESULTS Our findings demonstrate that patients are willing to share their experiences of food insecurity, despite the sensitivity of this topic. Screening elicited information about how patients cope with food insecurity and how this affects their ability to self-manage diabetes. Care providers found this information helpful in directing their care and support for patients. CONCLUSIONS Using a standardized, respectful method of assessing food insecurity can better equip health-care providers to support food-insecure patients with diabetes self-management. Further evaluation of this initiative is needed to determine how food insecurity screening can affect patients' self-management and related health outcomes.
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McBrien KA, Naugler C, Ivers N, Weaver RG, Campbell D, Desveaux L, Hemmelgarn BR, Edwards AL, Saad N, Nicholas D, Manns BJ. Barriers to care in patients with diabetes and poor glycemic control-A cross-sectional survey. PLoS One 2017; 12:e0176135. [PMID: 28459820 PMCID: PMC5411045 DOI: 10.1371/journal.pone.0176135] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 04/05/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS To determine and quantify the prevalence of patient, provider and system level barriers to achieving diabetes care goals; and to examine whether barriers were different for people with poor glycemic control (HbA1c ≥ 10%; 86 mmol/mol) compared to fair glycemic control (7 to <8%; 53-64 mmol/mol). METHODS We administered a survey by telephone to community-dwelling patients with diabetes, to examine patient-reported barriers and facilitators to care. We compared responses in individuals with HbA1c ≥ 10% (86 mmol/mol) against those with HbA1c between 7-8% (53-64 mmol/mol). We examined associations between HbA1c group and barriers to care, adjusting for sociodemographic factors and diabetes duration. RESULTS The survey included 805 people with HbA1c ≥ 10% (86 mmol/mol), and 405 people with HbA1c 7-8% (53-64 mmol/mol). Participants with HbA1c ≥ 10% (86 mmol/mol) reported good access to care, however 20% of participants with HbA1c ≥ 10% (86 mmol/mol) felt that their care was not well-coordinated and 9.6% reported having an unmet health care need. In adjusted analysis, patients with HbA1c ≥10% (86 mmol/mol) were more likely to report lack of confidence and inadequate social support, compared to patients with HbA1c 7-8% (53-64 mmol/mol). They were also significantly more likely not to have drug insurance nor to have received recommended treatments because of cost. CONCLUSIONS These results reinforce the importance of an individualized, yet multi-faceted approach. Specific attention to financial barriers seems warranted. These findings can inform the development of programs and initiatives to overcome barriers to care, and improve diabetes care and outcomes.
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Affiliation(s)
- 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
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Laboratory Services, Calgary, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women’s College Hospital, Toronto, Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alun L. Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Canada
| | - Nathalie Saad
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Abstract
Food insecurity is an important issue in public health even in developed societies, particularly for vulnerable populations. Food insecurity refers to the uncertain or limited access to adequate and safe foods. Emerging evidence shows an association between food insecurity, type 2 diabetes risk factors, and management of type 1 and type 2 diabetes. A review of the current literature describing the association between food insecurity and diabetes reveals possible mechanisms and pathophysiologic pathways. There is less evidence for effective interventions, and much of the current literature is limited to cross-sectional studies. Future work should evaluate longitudinal associations and ways to help vulnerable patients with diabetes access adequate food for effective diabetes management.
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Affiliation(s)
- Utibe R Essien
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA
| | - Naysha N Shahid
- Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Seth A Berkowitz
- Harvard Medical School, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA.
- Division of General Internal Medicine and Diabetes Population Health Research Center, Massachusetts General Hospital, Boston, MA, USA.
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