- Access to health care. Accessing health care or preventive services may be difficult for lower income communities due to transportation challenges, hours of service, or financial barriers (Glazier, 2006).
- Health care coverage. Individuals with lower income may be less likely to carry health care insurance, or the insurance they carry may be insufficient to cover the cost of supplies and medication for diabetes (Busch, 2008-2009).
- Cost for a healthy lifestyle. The high cost of fresh fruits and vegetables, in comparison to processed foods, can prevent lower income individuals from adopting a healthy diet (Cassady, 2007).
- Cost for diabetes management. The medical care to manage diabetes can be costly; therefore, lower income individuals may take shortcuts in their self-care by cutting testing strips in half to make them last longer, or using their monitors less often. This increases the likelihood of improper management of the disease (Reichsman, 2009).
- Stress. Lower income individuals face social and economic pressure unlike other populations, which can make healthy eating, physical activity or proper disease management a lower priority compared to other issues (Turrell, 2002).
Strategies to address considerations
- Improve access to health care. Changes to the health system, like expanded hours of service, language translation, case management, reduction of financial barriers to health providers and medications, and changes in health care provider roles have potential to improve access to care and quality of care for the lower income population (Glazier, 2006). Automated voice messaging is an example of an outreach effort that can identify serious health problems that would otherwise go unnoted (Piette, 1997).
- Create opportunities for more affordable prevention and health care. It is important to consider costs for participants when developing and implementing diabetes interventions. This might be done by working with local businesses to provide lower cost glucose monitoring materials, or working with local recreation centers to get a sliding scale fee for individuals wanting to use their facilities (Glazier, 2006). Since cost of a healthy lifestyle is a barrier, intervention strategies should focus on providing low cost or free interventions in the community, such as: low cost fruits and vegetables in a market, community gardens, sliding fee scale in health clubs, or free activities in community public places, low cost or free diabetic supplies (Jenum, 2006).
- Address participant needs. Consider providing childcare, transportation, or any other type of assistance that will allow increased participation in diabetes intervention activities (Bank-Wallace, 2002).
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