A qualitative assessment of diabetes care access and disease management in Central America

Lauren J Jonkman; Martha Ndungu; Sharon E Connor; Vidya Balakrishna Sharma; Roshni Pattabiraman; Aarti Zaver; Tania Castillo; Mark Meyer

doi:10.1016/j.sapharm.2020.07.020

A qualitative assessment of diabetes care access and disease management in Central America

Res Social Adm Pharm. 2020 Nov;16(11):1542-1549. doi: 10.1016/j.sapharm.2020.07.020. Epub 2020 Jul 22.

Authors

Lauren J Jonkman¹, Martha Ndungu², Sharon E Connor³, Vidya Balakrishna Sharma³, Roshni Pattabiraman³, Aarti Zaver³, Tania Castillo⁴, Mark Meyer⁵

Affiliations

¹ University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA. Electronic address: ljf1@pitt.edu.
² University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA. Electronic address: mmn26@pitt.edu.
³ University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA.
⁴ Community Physician, Shoulder to Shoulder Pittsburgh, San José, San José del Negrito, Yoro, Honduras.
⁵ University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Shadyside, 6023 Harvard Street, Pittsburgh, PA, 15206, USA.

PMID: 32958443
DOI: 10.1016/j.sapharm.2020.07.020

Abstract

Background: Diabetes is a growing concern in low-and middle-income countries. Medical missions play a role in increasing access to care and medicines, but often ignore non-communicable disease prevention and advanced management. Increased knowledge of local community needs and resources can lead to the development and implementation of pharmacist-supported interventions to improve diabetes management in rural areas.

Objectives: The purpose of this study was to 1) understand the availability of monitoring for diabetes locally; and 2) describe knowledge and health beliefs regarding diabetes management for those with diabetes, and prevention among those at high risk of developing diabetes.

Methods: This qualitative evaluation used semi-structured interviews with key informants in a community in rural Honduras. Participants included those with diabetes, those at-risk for developing diabetes, and community leaders. Data was analyzed using thematic content analysis through an iterative process of coding and theme development.

Results: A total of 35 interviews were conducted with five resulting themes: 1) participants identified multiple barriers to diabetes management including access to monitoring, access to certain medications, and access to advanced levels of care; 2) participants acknowledge the relationship between lifestyle choices and diabetes control, but struggled with adherence to a healthy lifestyle; 3) participants identify that they have limited knowledge of diabetes pathophysiology, diabetes management, and strategies to prevent diabetes; 4) participants felt that opportunities existed within the community to support diabetes education and prevention, and 5) providers should integrate culture, societal norms, and religion in diabetes management.

Conclusion: This research identifies challenges and resulting opportunities for managing diabetes in rural Honduras. Health care providers including pharmacy personnel should consider strategies to engage communities around self-care and diabetes education. Further, strategies are needed to enhance access to resources and essential medicines for diabetes management. These themes can guide clinicians in supporting communities to enhance diabetes care.

Keywords: Barriers; Diabetes; Health beliefs; Honduras; Medical Mission; Non-communicable diseases; Rural Health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Central America
Diabetes Mellitus* / therapy
Disease Management*
Humans
Pharmacists*
Qualitative Research
Rural Population