243651 Managing diabetes and food insecurity in times of extreme economic hardship: A qualitative study of low-income diabetic safety net clinic patients

Monday, October 31, 2011

Katharine Rendle, MA, MSW , Department of Anthropology, University of Michigan, Ann Arbor, Palo Alto, CA
Suepattra May, PhD, MPH , Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
Caroline Tietbohl, BA , Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
Visith Uy, BS , Department of Medicine, University of California, Los Angeles, Los Angeles, CA
Dominick Frosch, PhD , Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
Introduction: Diabetes is one of the most prevalent chronic health conditions in the United States. Few studies have investigated the impact of food insecurity on the self-management practices of patients with diabetes. This study documents the experiences of low-income patients struggling to manage their diabetes in times of economic hardship and food insecurity.

Methods: We conducted semi-structured interviews with English and Spanish speaking Type II diabetes patients (N=20) receiving care at a Safety Net Clinic in Southern California. Data were coded for key themes using ATLAS.ti Qualitative Data Analysis software.

Results: The majority of participants (55% male) were Latino (40%) or African American (25%) and 54 years old, on average. These patients (1) frequently experienced cycles of food scarcity and abundance depending upon receipt of income (i.e. arrival of paycheck, welfare benefits, contract work) (2) were forced to manage competing economic demands such as paying rent or electricity over purchasing healthy food, further exacerbating the health impacts of food insecurity, and (3) employed creative strategies to incorporate clinical recommendations of portion control that often resulted in reducing daily food consumption rather than incorporating more healthy food items.

Discussion: With referral Medicare currently covers three hours annually of medical nutritional therapy for people with diabetes. It is unclear if low-income patients utilize such services. Our findings underscore the urgent need to assess the health impact of food insecurity on diabetes management among low-income patients. Further, policy makers should be aware of the direct health implications of the thinning social safety net.

Learning Areas:
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
1. Describe strategies for diabetes self-management as reported by a population of low-income safety net clinic patients in Southern California. 2. Identify challenges and barriers to increasing healthy food intake in these patients. 3. Discuss potential mechanisms to inform future interventions to decrease the health impact of food insecurity on low-income patients.

Keywords: Diabetes, Food Security

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present as I conduct research on social determinants of health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.