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. 2024 Dec;39(16):3120-3128.
doi: 10.1007/s11606-024-09030-z. Epub 2024 Sep 23.

Homelessness and Type 2 Diabetes: A Qualitative Study of Facilitators and Barriers to Self-Management and Medication Adherence

Sarah Turcotte Manser  1 , Preethiya Sekar  2 , Zobeida Bonilla  3 , Becky Ford  2 , Nathan Shippee  3 , Andrew M Busch  4   5 , Lillian Gelberg  6 , Elizabeth A Rogers  1 , Latasha Jennings-Dedina  2 , Victor M Montori  7 , Katherine Diaz Vickery  8   9
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Homelessness and Type 2 Diabetes: A Qualitative Study of Facilitators and Barriers to Self-Management and Medication Adherence

Sarah Turcotte Manser et al. J Gen Intern Med. 2024 Dec.

Abstract

Purpose: In this study, we explore the barriers and facilitators to diabetes medication adherence and self-management for people with type 2 diabetes who have experienced homelessness.

Methods: We conducted five focus groups and two interviews with 26 participants. Our multi-disciplinary analysis team utilized principles of grounded theory and conducted thematic analysis with an inductive, iterative process to identify central themes.

Results: The majority of participants identified as Black/African American and over half stayed in shelters or had no steady place to stay at enrollment. Three key themes emerged regarding medication adherence and diabetes self-management for people who have experienced homelessness: personal autonomy and security, predictability and stability, and supportive, knowledgeable relationships (both social and medical). We define personal autonomy and security as individual agency and choice when making decisions related to one's health and well-being as well as protection from risk or harm to one's physical or psychological well-being, belongings, or means of income. Predictability and stability take place through the development of a system of connections and routines built over time where individuals can reliably adopt and maintain diabetes self-management activities. Supportive, knowledgeable relationships include medical and social relationships that offer encouragement, information, and hands-on care promoting diabetes self-management and connection to clinical care and resources. Participants also highlighted a "domino effect" where a cascade of events negatively and consequently impacted their health and well-being. We describe the interactions of these themes, the intersection of structural vulnerability and individual social risks, and resulting impacts on medication adherence and diabetes self-management.

Conclusions: Our findings highlight the structural vulnerabilities impacting people experiencing homelessness and identify inflection points of opportunity at structural and individual levels to strengthen diabetes medication adherence and self-management. This understanding can inform policy change and future tailored diabetes interventions.

Keywords: adherence; chronic illness; compliance; diabetes; homelessness.

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Conflict of interest statement

Declarations:. Disclaimer:: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflict of Interest:: There are no conflict of interest to report.

Figures

Figure 1
Figure 1
Facilitators and barriers to diabetes medication adherence and self-management among people who have experienced homelessness.
See this image and copyright information in PMC

References

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