Dlugatch Rachel, Rankin David, Evans Mark, Oliver Nick, Ng Sze May, Lawton Julia
Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK.
Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, UK.
Diabet Med. 2025 Apr;42(4):e15486. doi: 10.1111/dme.15486. Epub 2024 Nov 29.
We explored healthcare professionals' perceptions and understandings of the factors and considerations underlying inequities in technology access in children and young people (CYP) with type 1 diabetes.
We interviewed (n = 29) healthcare professionals working in paediatric diabetes in England recruited from (n = 15) purposively selected sites. We analysed data thematically.
Interviewees highlighted multiple, often overlapping barriers to accessing technology faced by CYP with type 1 diabetes from deprived and/or ethnic minority backgrounds. They described the impacts of deprivation on technology uptake, together with the complex social, ethnic and cultural factors that could also reinforce disparities in technology access. Interviewees further highlighted staffing shortfalls as a significant barrier to supporting CYP to use technology, especially those from under-represented groups who they perceived as requiring more staff time to be trained to use technology. While interviewees suggested that unconscious bias has become less prominent, they reported being less likely to recommend technology (especially pumps) to CYP/caregivers who they feared would not use it safely and effectively (e.g. those with low literacy levels). Interviewees also highlighted geographical variability in the technology commissioning process (a 'postcode lottery').
Our findings suggest that without targeted interventions, technology inequities may continue to persist amongst CYP from the most and least deprived areas and from white and ethnic minority groups in the United Kingdom. Additionally, our findings suggest that closing the technology gap will require large-scale governmental and health policies aimed at fostering socioeconomic, ethnic and cultural equality alongside targeted measures to improve technology accessibility.
我们探讨了医疗保健专业人员对1型糖尿病儿童和青少年（CYP）在技术获取方面存在不平等现象的潜在因素和考量的看法与理解。
我们对在英格兰从事儿科糖尿病工作的29名医疗保健专业人员进行了访谈，这些人员来自15个经过有目的选择的地点。我们对数据进行了主题分析。
受访者强调了来自贫困和/或少数族裔背景的1型糖尿病CYP在获取技术方面面临的多种且往往相互重叠的障碍。他们描述了贫困对技术采用的影响，以及复杂的社会、种族和文化因素，这些因素也可能加剧技术获取方面的差距。受访者进一步强调人员短缺是支持CYP使用技术的一个重大障碍，尤其是那些来自代表性不足群体的CYP，他们认为这些群体需要更多的工作人员时间来接受技术使用培训。虽然受访者表示无意识偏见已不那么突出，但他们报告称，不太可能向他们担心无法安全有效使用技术的CYP/护理人员推荐技术（尤其是泵）（例如识字水平低的人）。受访者还强调了技术委托过程中的地域差异（“邮编抽奖”）。
我们的研究结果表明，如果没有针对性的干预措施，技术不平等现象可能会在英国最贫困和最不贫困地区的CYP以及白人和少数族裔群体中持续存在。此外，我们的研究结果表明，缩小技术差距需要大规模的政府和卫生政策，旨在促进社会经济、种族和文化平等，同时采取针对性措施提高技术可及性。
