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Adverse Social Determinants of Health in Children with Newly Diagnosed Type 1 Diabetes: A Potential Role for
Charlene W Lai1, Meghan Craven2, Jennifer A Hershey3
1Division of Pediatric Endocrinology, Oregon Health and Sciences University, 700 SW Campus Drive, Portland, OR 97239, USA.
Insights
Adverse social determinants of health significantly impact pediatric type 1 diabetes care. Community health workers (CHWs) show promise in supporting families facing these challenges, improving the transition home after diagnosis.
Area of Science:
- Pediatric Endocrinology
- Public Health
- Health Disparities
Background:
- Socioeconomic and racial disparities affect glycemic control in children with type 1 diabetes (T1D).
- Community health workers (CHWs) are effective in improving outcomes for marginalized, high-risk populations.
- Understanding the impact of social determinants of health (SDOH) is crucial for pediatric T1D management.
Purpose of the Study:
- To describe the prevalence and impact of adverse SDOH on pediatric T1D care post-diagnosis.
- To investigate the supportive role of CHWs in managing T1D amidst SDOH challenges.
Main Methods:
- Qualitative study involving caregivers of children (<17 years) with new-onset T1D and government insurance.
- Baseline demographic and SDOH questionnaires administered at enrollment.
- Semistructured interviews conducted at 3 months post-diagnosis to explore SDOH effects and CHW impact.
Main Results:
- Two-thirds of caregivers reported at least one SDOH need; 35% reported two or more.
- Caregiver employment and financial issues were major barriers to diabetes care.
- Families working with a CHW experienced an improved transition from hospital to home, with CHWs acting as a key support.
Conclusions:
- Adverse SDOH are prevalent in families of children newly diagnosed with T1D, significantly impacting care capabilities.
- Preliminary findings suggest CHWs can facilitate pediatric diabetes care.
- Further research is warranted to optimize CHW interventions for T1D management in underserved populations.
Objective:
There are significant socioeconomic and racial disparities in glycemic control among children with type 1 diabetes (T1D). Community health workers (CHWs) have been shown to improve outcomes in marginalized, high-risk populations. The purpose of this qualitative study was to describe the prevalence and the impact of adverse social determinants of health (SDOH) on diabetes care soon after a diagnosis of pediatric T1D, and investigate the potential supportive role of a CHW. Research Design and Methods. Caregivers of youth <17-year old, with new onset T1D, and government insurance at the time of diagnosis were enrolled. Baseline demographic and SDOH questionnaires were administered at the time of enrollment. Semistructured interviews were performed at 3 months after diagnosis to explore the effect of SDOH on diabetes care and the impact of a CHW.
Results:
Seventeen caregivers were enrolled, 10 were randomly assigned to a CHW. Two-thirds of caregivers identified at least one SDOH need at enrollment; 35% of caregivers identified two SDOH needs. Interviews revealed that the two major themes identified as barriers to diabetes care were caregivers' employment and financial issues. Social support was identified as a facilitator. The transition from hospital to home after the diagnosis of T1D was improved for families working with a CHW, and the CHW was identified as a strong source of support.
Conclusions:
There is a high prevalence of adverse SDOH in families from lower socioeconomic status at the time of diagnosis of pediatric T1D. These SDOH have a significant impact on families' abilities to care for their children. Preliminary data suggest that CHWs can be a facilitator to the diabetes care. This trial is registered with NCT04238949.
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