Personal barriers to diabetes care: lessons from a multi-ethnic community in New Zealand

The aim of this study was to identify and quantify barriers to diabetes care perceived by diabetic subjects from a multiethnic, urban community (mainly New Zealand Europeans, Maori, and Pacific Islanders). A qualitative survey including 57 diabetic subjects and health care providers from a diverse range of backgrounds was followed by a cross-sectional household survey. Barriers to care were quantified among 1862 (2.1%) diabetic residents of a total surveyed population of 90477. Thirty barriers to care categories were generated incorporating patient beliefs, internal and external physical barriers, educational, psycho-social and psychological barriers. In spite of major difference in culture, acculturation, and socio-economic status, the top 10 barriers were similar between the ethnic groups. The most important barriers were perceiving that the benefits of self-care were outweighed by the disadvantages (20% Europeans, 20% Maori, 29% Pacific Islanders, 16% others, p<0.001), lack of community-based services (13% Europeans, 27% Maori, 25% Pacific Islanders, 11% others, p<0.001) and the limited range of services available (15% Europeans, 22% Maori, 20% Pacific Islanders, 14% others, p<0.05). It is postulated that definition of these barriers, with subsequent, systematic action to reduce their impact, in both patients and populations could result in an improvement in diabetes outcomes.