Indigenous Australian perspectives on incorporating the social determinants of health into the clinical management of type 2 diabetes

Abstract

Introduction: Type 2 diabetes mellitus and social disadvantage are related. In Australia, this association is most pronounced among Indigenous Australians (Aboriginal and Torres Strait Islander peoples). Indigenous Australians are among the most socially disadvantaged in the country, having the worst social determinants of health (SDoH). SDoH are typically addressed at a population level, and not on an individual or a clinical level.However, the SDoH-related needs of individuals also require attention. The adverse link between type 2 diabetes and SDoH suggests that simultaneous consideration at an individual, clinical level may be beneficial for type 2 diabetes care and selfmanagement. Identifying and addressing SDoH-related barriers to type 2 diabetes self-management may augment current care for Indigenous Australians. This study aimed to combine the perspectives of Indigenous Australians with type 2 diabetes and Indigenous health workers to explore the SDoH-related barriers and facilitators to self-managing type 2 diabetes, and how SDoH could be incorporated into the usual clinical care for Indigenous Australians with type 2 diabetes. Methods: Under the guidance of a cultural advisor and Indigenous health workers, seven Indigenous Australians with type 2 diabetes and seven Indigenous health workers from rural and remote north Queensland, Australia, participated in a series of semi-structured, in-depth face-to-face interviews and yarning circles. A clinical yarning approach to data collection was used, and both an inductive and a deductive data analysis were applied. Data were analysed, and themes were identified using NVivo v12.Results: Study participants described a holistic view of health that innately includes SDoH. Specific to type 2 diabetes care, participants identified that culturally responsive service delivery, suitable transport provision, an infinite flexible approach to accommodate for individuals' unique social circumstances, appropriate client education and appropriate cultural education for health professionals, support mechanisms and community support services were all essential components. These were not seen as separate entities, but as interrelated, and all were required in order to incorporate SDoH into care for Indigenous Australians with type 2 diabetes. Conclusion:SDoH are implicit to the Indigenous Australian holistic view of health. Consequently, an approach to type 2 diabetes care that complements this view by simultaneously considering SDoH and usual type 2 diabetes clinical management could lead to enhanced type 2 diabetes care and self-management for Indigenous Australians.

Improving type 2 diabetes care and self‐management at the individual level by incorporating social determinants of health

“…All participants were non‐Indigenous. Indigenous Australian perspectives are reported in a separate paper 15 …”

Incorporating social determinants of health into individual care—a multidisciplinary perspective of health professionals who work with people who have type 2 diabetes

“…Table 2 displays participant discipline, role and demographic information. All study participants were non-Indigenous as the perspectives of Australian Aboriginal and Torres Strait Islander health workers are published in a separate paper [ 28 ].…”

Pharmaceutical management of type 2 diabetes among Indigenous Australians living in urban or rural locations: a comparative study using a national general practice database

“…5 This finding can impact the choice of medication prescribed to Aboriginal and/or Torres Strait Islander Peoples who are often over-represented in poor socioeconomic circumstances. 10,30 The strengths of the study include using the MedicineInsight database, a large national general practice database collecting de-identified information about those presenting to mainstream GP clinics throughout Australia. It has been used for analysis in previous studies, and given that it collects data from most geographic regions across Australia, it provides interesting national insights into primary care.…”

“…Our findings were consistent with other national data from the AIHW that reported insulin use for people living with type 2 diabetes was higher in urban locations compared to very remote areas, and insulin prescriptions were also more common in higher socioeconomic areas 5 . This finding can impact the choice of medication prescribed to Aboriginal and/or Torres Strait Islander Peoples who are often over‐represented in poor socioeconomic circumstances 10,30 …”