Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study

Abstract

Background The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City. Methods This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach. Results The sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers. Conclusions Evidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.

Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review

“…In the domain “reinforcement” (15 studies) [ 27 , 28 , 31 , 33 , 37 , 39 , 41 , 44 , 50 , 52 , 53 , 59 , 61 , 62 , 77 , 78 , 80 , 84 , 85 ], the lack of symptoms and the side effects of medication were seen as factors that could result in people with diabetes stopping the treatment (12 studies).…”

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…Studies included in our review consistently reported an increased prevalence of diabetes with age. Diabetes care challenges specific to this age group include risk of obesity or undernutrition [ 42 , 56 ], increased risk for disability [ 57 ], economic barriers to appropriate access to health care [ 42 ], disruption in funding of health insurance [ 275 ], disparate completion of diabetes care guidelines based on health insurance coverage [ 276 ], inequalities in access to and utilization of health care services [ 277 – 279 ], complex medical care needs and frailty [ 280 ], cultural beliefs, mental health, and lack of family or social support [ 281 ], among others. Prevention of diabetes and its complications and reliable continuity of care and social support [ 282 ] need to be especially tailored for this population across the region.…”

Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico

“…We also explored how the cultural context, family, and health system shape beliefs and practices, and deliver or support care related to T2D. This qualitative study has been published [25]; in the following section, we summarize the main points that informed our intervention development.…”