Facilitators and Barriers to Diabetes Self-Management Among Patients at an Urban Safety-Net Hospital Restricted; Files Only

Telfort, Courtney (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/tq57ns31s?locale=en


Diabetes mellitus is a condition that affects 34.2 million people in the United States. In Georgia, diabetes disproportionally affects minority populations and those who have lower education and income. People with diabetes are vulnerable to adverse health outcomes such as blindness, kidney failure, and lower limb amputations, particularly if they experience challenges with adherence to medications and health recommendations, including lifestyle changes. Social support from family, friends and providers have been found to assist with diabetes self-management (DSM). Continuous glucose monitoring (CGM) devices and other resources decrease the numbers of finger pricks needed for glucose monitoring, making it easier for patients. Currently, studies discussing the barriers to and facilitators of DSM for patients accessing care at urban safety-net hospitals is very limited. In order to determine the facilitators and barriers to DSM for patients of the Diabetes Clinic at Grady Memorial Hospital in Atlanta, a qualitative study involving 18 patient and provider in-depth interviews (IDI) was conducted. Provider IDIs discussed demographics of their patient population, barriers and facilitators for patient DSM, and technology-based self-management resources. Patient IDIs discussed health habits, successes and challenges with DSM, and experiences with CGM and other technology-based resources. Facilitators of DSM included several technology-based aids like apps and CGM devices, but also involved clinical resources, social media, and other aids. The main barriers to DSM included challenges associated with technology-based aids like apps and CGM devices, financial issues, literacy challenges, and other general barriers. DSM apps, food tracking apps, and the CGM devices were convenient for patients and were preferred over traditional methods. Financial strain was the main barrier to DSM discussed by participants. Limited and inconsistent funds made it challenging for patients to have the resources needed for DSM. Social support acted as both a barrier and a facilitator, depending on the situation. Findings in this study can be used to develop new resources or to improve current resources available to assist patients who experience similar challenges to this population.

Table of Contents

I. Introduction 1

a. Problem Statement 2

b. Purpose/Objective Statement 3

c. Significance Statement 3

II. Literature Review 4

a. Background

i. Medical Description of Diabetes 4

ii. Symptoms of Diabetes 4

iii. Long-term Effects of Diabetes 5

iv. Overall Burden of Disease 5

b. Social Determinants of Health 6

i. Geographic Disparities 6

ii. Racial Disparities 7

iii. Disparities Present in Georgia 7

c. Facilitators of Diabetes Self-Management 8

i. Technology Aids 8

d. Barriers to Diabetes Self-Management 9

e. Gaps in Research 10

III. Methods 11

a. Study Design 11

b. Data Analysis 11

IV. Results 12

a. Overview 12

b.  Facilitators 12

i. Apps 13

ii. CGM Devices and Accessories 13

iii. Clinical Resources 15

iv. Social Media 16

v. Other Aids 16

c. Barriers 18

i. Apps 18

ii. CGM Devices and Accessories 18

iii. Finances and Supplies 19

iv. Health Literacy 20

v. CGM-Assisted Diabetes Literacy 21

vi. Technology Literacy 22

vii. Other Barriers 22

d. Social Support 24

V. Discussion 26

a. Conclusions 30

VI. Implications 30

VII. References 32

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