Exploring structural barriers to diabetes self-management in Alberta First Nations communities

Area of Science:

• Public Health
• Indigenous Health
• Diabetes Management

Background:

• Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities.
• FN individuals with diabetes experience disparities in care access and self-management.
• Systemic and racial factors contributing to these disparities are known, but individual experiences with barriers are under-characterized.

Purpose of the Study:

• To explore the structural barriers to diabetes self-management experienced by FN individuals.
• To gain insight into the lived experiences of FN individuals with diabetes regarding self-management.

Main Methods:

• Qualitative descriptive analysis of a subcohort of 5 FN individuals with diabetes.
• Semi-structured telephone interviews to gather information on diabetes and self-management barriers.
• Inductive thematic analysis performed in duplicate using NVivo 10.

Main Results:

• Structural barriers to diabetes self-management for FN individuals are distinct from non-FN populations.
• Common barriers include transportation difficulties, financial constraints for uninsured services, and insufficient access to diabetes education leading to knowledge gaps.
• Unlike non-FN populations, medication costs are generally covered for FN individuals with status.

Conclusions:

• FN Albertans with diabetes encounter numerous self-management barriers, influenced by colonialism, historical injustices, finances, geographic isolation, and lack of education.
• These FN-specific barriers impede optimal diabetes management.
• Targeted programs addressing these unique barriers are recommended to enhance diabetes self-management in this population.