Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI.
Ethn Dis. 2021 Oct 21;31(4):527-536. doi: 10.18865/ed.31.4.527. eCollection 2021 Fall.
Despite evidence that food insecure African Americans with type 2 diabetes are at particularly high risk for poor health outcomes, there is currently a lack of information on their lived experience. This qualitative study aimed to identify challenges, facilitators, and barriers to effective diabetes care for food insecure African Americans with type 2 diabetes residing in an inner city.
In fall 2018, we conducted two focus groups attended by a total of 16 food insecure adults with type 2 diabetes residing in the inner city of Milwaukee, Wisconsin. A standardized moderator guide included questions to explore the role of food insecurity in managing diabetes, and facilitators that improve diabetes management within the context of food insecurity. Focus groups were audio recorded and recordings were transcribed by a professional transcription service. A grounded theory approach was used for analysis.
Six major challenges existed at the individual level (diet/nutrition, exercise, diabetes knowledge and skills, complications from diabetes, a family history of diabetes, and a preoccupation with food). Five major barriers and facilitators existed both internally and externally to the individuals (access to food, medications, stress, cost of health-related needs and religion/spirituality).
This study identified multiple challenges, barriers, and facilitators to effective care for food insecure African American adults with type 2 diabetes. It is imperative to incorporate this understanding in future work by using an ecological approach to investigate strategies to address food insecurity beyond a singular focus on access to food.
尽管有证据表明，患有 2 型糖尿病的食物不安全的非裔美国人的健康状况尤其差，但目前他们的生活经历信息却很缺乏。本定性研究旨在确定居住在城市内部的患有 2 型糖尿病且食物不安全的非裔美国人在有效进行糖尿病护理方面所面临的挑战、促进因素和障碍。
2018 年秋季，我们举办了两次焦点小组会议，共 16 名居住在威斯康星州密尔沃基市城市内部的患有 2 型糖尿病且食物不安全的成年人参加了会议。一个标准化的主持人指南包括探索食物不安全对管理糖尿病的作用的问题，以及在食物不安全的情况下改善糖尿病管理的促进因素。焦点小组的讨论内容被录音，并由专业的转录服务转录成文字。采用扎根理论方法进行分析。
个体层面存在 6 个主要挑战（饮食/营养、运动、糖尿病知识和技能、糖尿病并发症、糖尿病家族史和对食物的关注）。内部和外部都存在 5 个主要障碍和促进因素（获取食物、药物、压力、健康相关需求的成本和宗教/精神信仰）。
本研究确定了多种有效护理患有 2 型糖尿病且食物不安全的非裔美国成年人的挑战、障碍和促进因素。至关重要的是，未来的工作必须将这种理解纳入其中，采用生态方法来调查解决食物不安全的策略，而不仅仅是单一地关注获取食物。
