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Title: Socioeconomic factors influencing equitable access to intensive insulin regimens for adults with type 1 diabetes
Author: Scott, Anne
ISNI:       0000 0004 5923 6587
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2016
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Introduction: Type 1 diabetes is a chronic condition in which self-care is critical to successful outcomes. Intensive insulin regimens can reduce morbidity and mortality associated with the condition. However, socioeconomic inequalities have been demonstrated in both access to treatment and health outcomes for adults with the disease. This study investigates how socioeconomic factors influence access to intensive regimens. Methods: A qualitative study of a specialist diabetes service was undertaken. Interviews with 28 patients and 6 health care professionals explored factors influencing equity in gaining access to an intensive regimen. Conversation analysis of 25 consultations between patients and specialists explored factors influencing equity in maintaining access. Analysis was framed using the Candidacy theory for access to health care for vulnerable groups. Findings: Gaining access to intensive regimens was dependent on accessing specialist services. Disparities in the utilisation of specialist services appeared to relate to the permeability of these services, personal social circumstances (low paid work and transport difficulties) and the variable ability of patients to navigate the health care system. Factors diminishing candidacy for intensive regimens were low health literacy, non-alignment with health care professional goals, psychosocial problems and poor quality patient-provider communication. Conversation analysis identified that patient involvement with health care professionals was important for maintaining access. In this sample, 'low involvement' patients were at risk of losing access and were from lower socioeconomic groups. Some barriers to access were modifiable through contact with diabetes specialist nurses, a Structured Education Programme and continuity of care with specialists. Discussion: Equitable access to intensive regimens was impeded for people from lower socioeconomic groups by a complex mix of factors relating to the permeability of specialist services and patient interactions with health care providers. Efforts to facilitate access to specialist services and to improve the quality of communication could lessen inequities in access to intensive regimens.
Supervisor: O'Cathain, Alicia ; Goyder, Elizabeth Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available