Gazmararian Julie A, Ziemer David C, Barnes Catherine
The Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Gazmararian)
School of Medicine, Emory University, Atlanta, Georgia (Dr Ziemer, Dr Barnes)
Diabetes Educ. 2009 Sep-Oct;35(5):778-88. doi: 10.1177/0145721709338527. Epub 2009 Jun 25.
The purpose of this study was to explore individual, educational, and system barriers that limit low-income diabetes patients' ability to achieve optimal diabetes self-management.
Economically disadvantaged patients with diabetes who used the Diabetes Clinic of Grady Health System in Atlanta, Georgia, participated in 3 focus group discussions.
The discussions were held with mostly African Americans (n = 35) to explore barriers to achieving optimal diabetes self-management. Most participants were not married, approximately one-third had less than high school level reading skills, and 40% were not currently working. In terms of individual barriers, the emotional toll from the diagnosis of and lifestyle changes to treat diabetes was a recurrent theme, and included stress, frustration, social isolation, interpersonal conflicts, depression, and fear. Denial was often mentioned as the key factor that inhibited adherence to a healthy mode of living. The educational barriers were failure to recognize the risks and consequences of an asymptomatic condition. Many participants did not understand A1C. Finally, several system barriers were identified. The participants identified needed services, including follow-up and refresher courses, support group discussions, nutrition and medication education, availability of different education modalities, and expanded clinic hours.
The focus group discussions identified both barriers to diabetes management and opportunities for improving care for underserved patients with diabetes. The results are useful to improve the delivery of care and to develop quantitative studies to explore particular areas of interest. Based on these results, the current system needs to provide more support and education to patients with diabetes.
本研究旨在探讨限制低收入糖尿病患者实现最佳糖尿病自我管理能力的个人、教育和系统障碍。
在佐治亚州亚特兰大市格雷迪健康系统糖尿病诊所就诊的经济弱势糖尿病患者参加了3次焦点小组讨论。
讨论主要与非裔美国人（n = 35）进行，以探讨实现最佳糖尿病自我管理的障碍。大多数参与者未婚，约三分之一的人阅读技能低于高中水平，40%的人目前没有工作。在个人障碍方面，糖尿病诊断和治疗带来的生活方式改变所造成的情感负担是一个反复出现的主题，包括压力、挫折感、社会隔离、人际冲突、抑郁和恐惧。否认往往被认为是阻碍坚持健康生活方式的关键因素。教育障碍是未能认识到无症状疾病的风险和后果。许多参与者不理解糖化血红蛋白（A1C）。最后，确定了几个系统障碍。参与者指出了所需的服务，包括随访和复习课程、支持小组讨论、营养和药物教育、不同教育方式的可用性以及延长诊所营业时间。
焦点小组讨论确定了糖尿病管理的障碍以及改善糖尿病患者医疗服务的机会。这些结果有助于改善医疗服务的提供，并开展定量研究以探索特定感兴趣领域。基于这些结果，当前系统需要为糖尿病患者提供更多支持和教育。
