Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review

Abstract

Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.

Barriers and enablers to structured care delivery in Australian rural primary care

“…With workforce challenges comes the inadequacy and perceived instability of health services and service gaps. [14][15][16][17]21,22,29,30,32,36,39,40,43 For example, in a study of the barriers to effective mental health care for older people in a rural region of Australia, inadequacy of mental health services or services being at capacity was reported. 39 With services being at capacity due to workforce shortages, there are a lack of appointments, reduced service operating hours, long wait periods and reduced appointment flexibility.…”

“…Lack of adequate or consistent funding and resourcing has been reported to be a barrier to structured care delivery. 13,[16][17][18][19][20][21]24,26,28,30,31,[34][35][36]38,40,41,[43][44][45][46] Piecemeal funding across multiple government and non-government organisations is complex, resulting in service inconsistencies. 17 Costs incurred by services in delivering planned care as well as the cost for patients to access care have also been reported as barriers.…”

“…17 Costs incurred by services in delivering planned care as well as the cost for patients to access care have also been reported as barriers. 13,16,43,44 Gador-Whyte et al 19 found that when all chronic disease management tasks were completed for patients with diabetes and chronic kidney disease, a funding gap of $1733 per patient per annum was incurred by the health service. Additionally, a literature review conducted by Street et al 44 identified the costs associated with shared care to be a barrier to continuity of care for people with chronic conditions.…”

Leisure and Leisure Education as Resources for Rehabilitation Supports for Chronic Condition Self-Management in Rural and Remote Communities

“…Chronic physical or mental condition self-management involves managing symptoms alongside the management of the psychosocial and practical impacts of the condition on everyday life [e.g., changes in valued activities, roles and relationships ( 3 )]. Chronic condition self-management is often challenging ( 4 ), with additional challenges present for those living in rural and remote communities ( 5 ). For example, rural-dwelling individuals living with chronic conditions are at greater risk of worsening symptoms and poorer health (e.g., multimorbidities) due to experiencing greater health disparities (e.g., higher rates of poverty, lower levels of education and health literacy) than urban-dwelling individuals ( 6 , 7 ).…”

“…For example, rural-dwelling individuals living with chronic conditions are at greater risk of worsening symptoms and poorer health (e.g., multimorbidities) due to experiencing greater health disparities (e.g., higher rates of poverty, lower levels of education and health literacy) than urban-dwelling individuals ( 6 , 7 ). One of the greatest disparities is access to health care ( 5 , 8 , 9 ). Sharp et al ( 10 ) identified distance as a key barrier in remote areas, which is further complicated by limited health resources such as healthcare facilities and trained practitioners.…”