A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area

Nina Ingemann Christensen,1 Sabina Drejer,1 Karin Burns,2,3 Sanne Lykke Lundstrøm,2 Nana Folmann Hempler1 1Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark; 2Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; 3Department of Endocrinology and Cardiology, Copenhagen University Hospital, Hvidovre, DenmarkCorrespondence: Nana Folmann Hempler Tel +45 40 732 591Email Nana.folmann.hempler@regionh.dkBackground: Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM.Aim: To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs).Methods: Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation.Results: The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one’s social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs.Conclusion: Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.Keywords: diabetes self-management, type 2 diabetes, vulnerable target groups, ethnic minorities, health inequities, socially disadvantaged population