The big challenge out here is getting stuff: How the social determinants of health affect diabetes self-management education for seniors

Abstract

In Canada, diabetes self-management education (DSME) programs are offered to enable individuals with diabetes to successfully implement and sustain lifestyle changes, with the goal of reducing risk of complications and morbidity. Researchers have demonstrated how older adults with diabetes often fail to achieve or maintain diabetes self-management (DSM) competencies, increasing complication risk. Further, little is known about the influence of the social determinants of health (SDH) on DSME, potentially producing additional inequalities for these adults; the WHO defines SDH as non-medical factors (e.g., education; food insecurity) that impact health outcomes. The study goal was to better understand how the SDH affect DSME for older adults living with diabetes. Methods: In our qualitative study we used participatory, art-based, and hermeneutic phenomenology research methodologies. Data collection included photovoice and semi-structured phone interviews. Fourteen older adults with diabetes participated (11 men, 3 women; aged 65 years or older). A SDH framework (Loppie-Reading and Wien) guided the thematic analysis. Results: The findings illuminate how participants live with the effects and pressures of the SDH. Proximal determinants of health revealed in participants’ stories included health behaviours (diabetes self-management practices), physical environments (rurality), socioeconomic status (income), and food insecurity (accessing healthy food). Intermediate determinants comprised health-care systems (accessing DSME in their community) and community resources and capacities (limited infrastructure due to rurality). Distal determinants involved the pandemic (isolation due to mobilization restrictions). Conclusion: Our study demonstrated how the SDH affect DSME and DSM for older adults. Participants were continuously rearranging their diabetes needs to accommodate other life priorities. Additionally, rural living is described as a barrier to DSM, as accessing diabetes education, food, medications, and gas is at a distance—a particular inconvenience during wintertime. Our findings will guide future design, planning and implementation of DSME programs for older adults in this rural setting.

Intersectoral health interventions to improve the well-being of people living with type 2 diabetes: a scoping review protocol

“…17 19 Poor diabetes control is strongly associated with SDH such as physical inactivity, unhealthy diet, insufficient health education and financial hardships. [20][21][22] These determinants have a major influence on an individual's health status and can represent a lifelong risk. 23 As SDH are often beyond the control of individuals and healthcare professionals, 24 it is essential to consider patients' journeys within and outside the health and social services network, to adequately support them during their life course and better meet their needs.…”

Pursuit of Equity: Women on a Low Income Navigating Access to Health and Social Services in Canada

“…We followed Loppie-Reading and Wien's (2013) conceptual framework, which classifies the social determinants of health into distal (e.g., historical, political, social, and economic contexts), intermediate (e.g., community infrastructure, resources, systems, and capacities), and proximal (e.g., health behaviours, physical and social environment) categories. We have used this framework successfully to explore diverse experiences of health and social inequities in other equity-deserving groups, such as the experience of diabetes self-management education for older persons in a rural setting (Camargo-Plazas et al, 2022a;Robertson et al, 2023). This conceptual framework guided our thematic analysis of the data and provided a more comprehensive understanding of social inequities for women living on a low income in the city of Kingston.…”