Rural/Urban

  Population considerations

  • Access to health care. People living in rural communities may have trouble accessing health care due to scarce resources in surrounding areas, as opposed to people living in more urban or populated areas. It may be particularly difficult to access specialists required for diabetes care (Schraer, 2001). They may not have the transportation to go places to receive information, or help with issues related to diabetes.
  • Perception of health. Residents in rural areas are known to have a poorer perception of overall health, which limits their likelihood of receiving preventive care for diabetes (Hueston, 2000).
  • Provider availability. There are a limited number of specialty care providers, such as podiatrists, in rural areas. Therefore this reduces a rural population’s accessibility to needed specialty services (Balamurugan, 2009).
  • Environmental constraints. A lack of safety, sidewalks, parks or community-sponsored exercise facilities, and poorly designed communities can discourage individuals with diabetes living in urban areas from being active. In addition, living in poverty may be compounded with decreased access to healthy foods (Jenum, 2006).

  Strategies to address considerations

  • Improve access to health care. Strategies may include working with local governments, community-based organizations, faith-based organizations, and community members to increase access to health care and/or community transportation systems. Automated voice messaging is an example of an outreach effort that can identify serious health problems that would otherwise go unnoted (Piette, 1997).
  • Promote self-management. It is important to work with rural health care providers to increase the information they have on how to counsel and educate rural individuals in diabetes self-management (Engel, 1997). Providing diabetes self-management education at the primary care setting can have a greater positive impact on an individual (Siminerio, 2005).
  • Restructure the environment. Environmental opportunities, such as safe neighborhoods, parks and community interventions are essential to promoting an active lifestyle in urban areas. Promote community gardens to grow and share fresh vegetables as well as provide physical activity opportunities (Jenum, 2006).
  • Transportation. Arranging transportation with friends and family, or contracting church vans, school buses and medical transport vans can help address the barrier for those who do not have access to transportation to intervention activities. Designing interventions that take place in the home of the individual with diabetes also helps to reduce the barrier of access to services and transportation (Schraer, 2001).

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