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The intersection of food insecurity and diabetes.

The intersection of food insecurity and diabetes.

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Article
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Objective. To explore how food insecurity affects individuals’ ability to manage their diabetes, as narrated by participants living in a large, culturally diverse urban centre. Design. Qualitative study comprising of in-depth interviews, using a semistructured interview guide. Setting. Participants were recruited from the local community, three com...

Contexts in source publication

Context 1
... data analysis produced three main themes that captured the experiences of people with diabetes who are food inse- cure: (1) barriers to preparing and accessing appropriate food, (2) social isolation, and (3) enhancing agency and resilience (see Figure 1). ...
Context 2
... role of healthcare providers is pivotal in enhancing agency and resilience. Participants drew on the heartfelt help and practical diabetes management strategies received from healthcare providers who they found to be "genuinely caring," "gentle," and "loving" (see Interviewee 14). Feeling cared for was referred to as "the human factor" and resonated in the examples participants gave, serving as empowerment to better manage their diabetes. ...

Citations

... They traveled long distances to buy food less expensive. Similarly, Chan et al. (2015) established how food insecurity negatively affects DSM in individuals living in Ontario. Chan and colleagues found factors such as living on a low income, lack of knowledge about healthy food choices, multimorbidity, social isolation, and inadequate cooking facilities affect food acquisition, selection, and preparation for individuals with diabetes. ...
... Finances was also foremost for participants, even if they were retired [which does not equate to a good income], and income was identified as a critical element in DSM; in Saunders' (2019) integrative review regarding older adults with diabetes, they also identified cost of care as a self-management challenge. Individuals living on a low income have a higher incidence of poorer glycemic control, more diabetes complications, and higher mortality (Chan et al., 2015;Hsu et al., 2012;Seligman et al., 2012;Tanaka et al., 2012;Vest et al., 2013). Poverty is associated with inadequate DSM (Hsu et al., 2012;Vest et al., 2013). ...
Chapter
Mothers of young children in Kazakhstan experience challenges to do paid work as the result of flaws in the state policies, motherhood penalty in the labor market and cultural barriers in the family institution. Absence of parental leave for fathers, three years unpaid maternity leave and shortage of state-subsidized childcare services reinforce traditional breadwinner family institution where women are the main caregiver and increase gender inequality. The labor market factors preventing mothers from fulfilling their fullest potential are wage gender gap, discrimination, and employers’ reluctance to hire women of reproductive age, and a lack of flexible work options. Within the family sphere, women in Kazakhstan spend three times more time on unpaid domestic work compared to men and mothers of young children are likely to have higher workload. The research aims to explore the main barriers preventing mothers of children 1-6 aged from participating in the labor market in Kazakhstan. The research applied the qualitative research method and conducted three focus group discussions among 15 mothers of young children residing in cities Almaty in Southern Kazakhstan. The results demonstrate that women face cultural and family barriers to do paid work in cosmopolitan Almaty and experience challenges to enter and remain in the labor market as a result of underdeveloped state policies and motherhood penalty in the labor market. Mothers of children 1-6 aged in Kazakhstan need sufficient number of childcare services for children aged under 3 subsidized by the state, flexible work schemes at workplace and policy incentives for fathers to take paternity leave
... Lack of support system related to family, peer group, friends, society, finance, professional assistance and medical guidance leads to negative impact on self-care behaviour. Although an important element, most the research evidences reported existence of poor support system (13,16,20). Not getting desired support from family members, lack of agreement on decisions making and conflict with the family members put a significant challenge (17). ...
... Diabetes is a chronic ailment which needs lifelong adherence to many lifestyle modifications and treatment modalities. Degree and severity of symptoms have been found to be related with the practice of self-care care activities among diabetic persons (16,24). Moreover the presence of other comorbidities such as HTN, Hyperlipidaemia and obesity also impact significantly the self-management process. ...
... The lived experience of people living with diabetes reported many strains related to dehydration and binge eating during fasting (18). Moreover, cultural constraints and difficulty in dietary restriction has been identified as a major obstacle (15,16). ...
Article
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Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictions, lifestyle and behavioural modifications. Self-care management behaviors are very much essential to control glycaemic values and future complications. Although an import aspect leading to positive health outcomes among diabetic patients, diabetes self-care management is usually is a complex process. This narrative review summates barriers related to self-care management among people with diabetes. The literature was searched through databases like PubMed and google scholar with help of keywords and MeSH terminologies. Furthermore, selected articles reference list was also screened. It is concluded that self-care management in diabetes mellitus is often surrounded by many barriers. Deficiency of environmental resources and assisted strategies, poor awareness regarding self-care skills, lack of motivation and financial constraints are the major barriers faced by people with diabetes mellitus. Endeavour to withdraw barriers are prime in aiding people living with diabetes which will help to improve their quality of life and to attain positive results.
... Another study showed that household food insecurity among Canadians with diabetes increased the likelihood of unhealthy behaviors among this population (Gucciardi et al., 2009). In addition, food insecurity is associated with the difficulty of managing these chronic conditions (Chan et al., 2015). Recent research has also shown that food insecurity is associated with premature mortality. ...
Article
Food insecurity is a persistent public health problem, and it adversely affects multiple dimensions of health and well-being across various stages of life. Socio-economic characteristics is one of the key predictors of food insecurity and there exists a strong association between income and food insecurity. Since food insecurity is closely linked to deprivation of financial resources, research has been continued to examine the potential of government income support policies in mitigating food insecurity. Several studies have already demonstrated that income interventions alleviate household-level food insecurity. However, little is known about how these public policies affect adults and children, within the households, respectively. Using the Universal Child Care Benefit as an exogenous income shock, we estimate the relationship between income and food insecurity separately for adults and children. In Chapter 1, we use data from the public-use microdata files of the Canadian Community Health Survey (2005-2012) and employ a standard difference-in-differences methodology to assess the impact of a universal income transfer on food insecurity at the adult, child, and household levels. In 2006, the Canadian federal government introduced the Universal Child Care Benefit as an income support for families with children below the age of six years. This policy provided families with a monthly taxable benefit of $100 for each child, regardless of socio-economic conditions. We quantify the effects of this income transfer using two measures of self-reported food insecurity: a four-level categorical measurement (i.e., food-secure, marginally food-insecure, moderately food-insecure and severely food-insecure) and a continuous food insecurity scale. Our results based on both measures suggest that the transfer reduced the prevalence and severity of food insecurity at the child-level. The policy change increased the probability of being food secure and reduced the likelihood of experiencing any form of food insecurity for children from eligible households. In Chapter 2, we address the heterogeneity in the impact of the income transfer on food insecurity across households. Using the same dataset from the Canadian Community Health Survey (2005-2012) and again utilizing a difference-in-differences method, we estimate the policy effects across subpopulations differentiated based on living arrangements, highest educational attainment in the household and household income. Our findings from subgroup analyses reveal disparities in the policy impact and indicate statistically significant reductions in child-level food insecurity among two-parent households, those with secondary education and those with household income at or above the median. These heterogeneous estimates suggest that the universal income transfer likely could not lead to substantial improvements in food security for vulnerable subpopulations. Both chapter findings illustrate the need for disaggregating the food insecurity effects of income supplement and similar public policy interventions by different levels within and across households to help policymakers design better informed and targeted interventions.
... These challenges can be at various levels, including the health system-level or individual-level, and the types of challenges vary in different parts of the world. [22][23][24][25] At the individual level, besides compliance with the medicines, a sustained self-care practice is required to achieve the therapeutic goals. 25 In India, individual self-care is often at stake due to a lack of fragmented information systems and inadequate patient support. ...
Article
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Background Self-care practice by diabetic people is key to achieving therapeutic goals. The objectives of the study were to describe the self-care practice of adult people with type 2 diabetes in a rural area of Andhra Pradesh and to identify the determinants of poor self-care practice of this population. Methods A community-based cross-sectional study was conducted among the known diabetics in a rural PHC between November 2018 and October 2019. Self-care practices among the registered diabetes patients were described in seven domains as recommended by the American Association of Diabetes Educators (AADE). Risk factors were identified using univariate, followed by multivariate logistic regression. The risk for poor self-care score was expressed in odds ratio (OR) with 95% confidence interval (CI). Results A total of 727 participants were recruited for the study. The mean age of the participants was 57 years (SD: 9.5 years). The self-care was prominent in diet modification, physical activity, and physical activity components. The median self-care score of the participants was 14 (IQR = 12.5 to 15.5). 32.6% (95% CI: 31.6%–33.6%) participants had good self-care scores. With multivariate regression analysis, we found that widowed/separated (aOR 1.85, 95% CI: 1.2–3.0) was a risk factor for poor self-care scores; and skilled workers (aOR 0.28, 95% CI: 0.1–0.6) had a significantly lower risk compared to the unskilled workers. Conclusion Overall, self-care practices are poor in problem-solving, risk reduction and healthy coping behaviours. Low education and poor socio-economic status could be the most likely reasons for poor self-care practices.
... This agree with study conducted in Egypt by Ibrahim et al (2010) (30) who found that only 2.2% of the respondents adhered with dietary regimen and also Ikombele, 2011 (17) who founds that the most of patients were not following a controlled, planned diet and only 0.9%were following a controlled plan diet. Inconsistent with Malik et al (2016) (31) who found that lower percentage of participants were not fully adherent to dietary advice.The result also revealed that most of patients can't choose appropriate foods between basic meals ,this finding may be due to lack of knowledge about healthy meal and inadequate income this may significant barriers especially for patient with low income which can't get enough ,appropriate healthy food this supported by Chan et al.(2015) (32) ;byHolt (2012) (33) . The present study revealed that around nearly half of the patients were not examine their feet regularly this finding due to they hadn't know the importance for foot examination and lack of adequate knowledge to specific diabetic foot care barrier to foot care, for diabetes managements .This agree with study conducted in Saudi Arabia by Dikeukwu et al. , 2012 (34) who revealed that more than half of the diabetics checked their feet regularly, while nearly half didn't check it regularly. ...
Article
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Diabetes is a syndrome constituting a general public health problem and it's difficult for diabetic individual, their family to adhere to self-management and person with diabetes may face many barriers to perform optimal diabetes self-management. The aim of the study was to assess barriers to self-management among patients with type 2diabetes mellitus (T2DM). Materials and method: Descriptive research design was utilized to conduct this study. Sample: convenience sample of 100 adult patients from both sexes diagnosed with T2DM conducted in diabetic unit and clinic at specialized medical hospital in Mansoura University Hospital. Data were collecting using two tools; first tool was patient's health relevant information interview and second tool was patient ' s barriers to self-management. Result: There are many barriers affecting type 2 diabetic patients to participate in self-management and majority of the patients have insufficient or lack of adherence to self-managements and facing many barriers as educational, physical, psychosocial, financial and cultural barriers.
... In addition, this implies additional direct costs, for transportation, and opportunity cost, for time spent, in food purchasing (Hammelman 2018). This can be an even larger barrier to access when people experience health conditions that affect their physical mobility (Chan et al 2015). ...
... Another factor that emerged is that mothers prioritize food pricing and optimization of food usage when making food selections, often sacrificing quality ( Studies also documented food insecurity related psychological challenges faced by people who live in urban areas, like increased feelings of anxiety, worry, shame, and uncertainty (Piaseu et al 2004); and limited self-control for chronic disease, since it prevents access to proper nutrition (Chan et al 2015). ...
... An aspect that emerged from the literature refers to strategies used by the urban poor to obtain food and, among them, the use of food banks (Morton et al 2008;Chan et al 2015;Green-LaPierre et al 2012) and community kitchens (Chan et al 2015) stand out. Critically, while social protection and food assistance programs, such as community kitchens, help by providing access to basic nutrition, these are insufficient to fully resolve their food insecurity related challenges (Wicks et al 2006). ...
Article
Full-text available
The risks of food insecurity, Aboriginal and Torres Strait Islander people and other people with low-socioeconomic backgrounds, as by limited access to healthy food, include overweight and obesity, or chronic undernutrition. As a result, food insecure households are more likely to develop chronic health conditions, such as diabetes, hypertension and mental health issues. A conceptual framework has been developed that focuses on the particular difficulties to achieve household food security among the urban poor, in cities and regional towns, which informs preventive strategies to effectively improve food access. Clearly, according to the conceptual framework, multi-sectors changes are needed to address food insecurity, in particular to address poverty; in education, urban and regional renewal and development, provision of a basic living income for unemployed people, effective access to physical and mental health services, and social programs that better support families at risk of poverty.
... Food insecurity, a typical indicator of the lack of subsistence, broadly refers to the status of being without sufficient nutritious and safe food and having limited ability to acquire such food (2)(3)(4) . Food insecurity generally has adverse effects on health and is associated with diabetes (5) , obesity (6) , psychological stresses and depression (7,8) , children's inadequate physical development and diverse illnesses (9,10) and underutilisation of medical care resources (11) . Therefore, many countries have endeavoured to tackle food insecurity problems of socioeconomically vulnerable groups by improving existing food systems and implementing food aid programmes (1,6) . ...
Article
Objective Given the competing needs for food and housing under the limited household income among poor families, there is lack of research on the associations between housing affordability and food insecurity. This study examines how housing cost burden affects food insecurity of low-income families and whether decreased housing cost enhance food security. Design Longitudinal data from the Korean Welfare Panel Study, of which the final sample for the analysis consisted of 31,304 household-level observations from 5,466 households based on 12 waves (2007-2018) Setting South Korea Participants Low-income households in the lowest 40% of household income distribution Results 19.3% had food insecurity, and housing cost burden was associated with food insecurity. While in-kind housing assistance and in-cash assistance from all sources were likely to reduce food insecurity partially through influencing housing cost burden, in-cash housing assistance was associated with higher likelihood of food insecurity. Conclusions Housing cost burden potentially limits food access among poor families, and housing assistance, particularly public housing and sufficient in-cash assistance, are conducive to alleviating food insecurity.
... In fact, all studies but one were rated as having dense and rich qualitative data; with the exception of a study focusing on FI among homeless and marginally housed adults in Sydney, Australia [104]. Qualitative studies applied different data collection techniques such as in-depth interviews [92,95,96,98,99,101,103,104], focus groups [93,94,97,101], participant observation [95,101], open-ended questionnaires [102] and photovoice [100]. ...
... These studies provide evidence that healthy diets are expensive, which leads to dose-response socioeconomic inequities in food choices. For example, in urban settings budgetary restrictions in the selection of food can lead to the consumption of diets that are very low in animal protein [51], or may disrupt requirements among populations with special dietary needs [92,101]. Urban dwellers in the lowest income deciles, allocate a higher proportion of their family income to food consumption [41,57], and may find restrictions to buying healthy foods [93]. ...
... time spent) in food purchasing [99]. This can be an even larger barrier to access when experiencing health conditions affecting physical mobility [92]. ...
Article
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Background There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this “urban advantage” does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition. Objectives This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.’s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis. Results Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition. Conclusions This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the “urban advantage”. A conceptual framework emerging from the existing literature is proposed to guide future studies and policies. Systematic review registration PROSPERO Registration number: CRD42018089788 .
... Those who experience financial strain, adverse life events, and are living in food insecure households without support from friends and family, have less opportunity to eat healthful foods, or even eat at all 15 . This impacts on their ability to manage conditions such as type 2 diabetes 16 , potentially putting them at risk of adverse consequences. ...
Technical Report
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Eating a balanced diet can benefit both physical and psychological health. Eating behaviour is influenced by what we know and what we can do (capability); the people around us and our physical environment (opportunity); and our beliefs, what we want, how we see ourselves, how we regulate our emotions, and our habits (motivation). To support possible changes to eating behaviour since Covid-19: Consider whether any disruption to daily routines, finances, access to food, storage/cooking facilities and/or social support may have influenced people's ability to eat a balanced diet. Where needed, proactively put in place strategies to mitigate influences on eating behaviour (e.g. food provision for those with lack of access). Promote alternative ways to regulate emotion if eating behaviour has been influenced (e.g. due to anxiety, low mood or boredom). Facilitate planning of how to eat a balanced diet in the event of unpredictable circumstances (e.g. ensuring food essentials are available in the home if there is a need to self-isolate/quarantine). Promote eating a balanced diet for the benefit of physical health and psychological wellbeing, particularly in relation to boosting the immune system. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/Covid-19%20Public%20Health%20Road%20Map%20-%20Eating%20behaviour.pdf
... To increase the number of qualifying participants, we modified the recruitment criteria following the advice of the network's chief medical officer to allow HbA1c up to 90 days (increased from 30 days) before enrollment. Fourth, data on participants' dietary intake, diabetes-related self-care, and stress have been shown to influence GC 13,41 and may mediate the relationship between food insecurity and GC and should be explored in future research. Fifth, the variables in our regression model (e.g., medication adherence) are self-reported and other variables that may influence glycemic control (e.g., changes in weight, dietary data) were not collected. ...
Article
Purpose Examine a clinic-based approach to improve food security and glycemic control among patients with diabetes. Design One-group repeated-measures design. Setting Federally Qualified Health Centers in a large Midwest city. Sample Of the 933 patients with diabetes who consented at baseline, 398 (42.66%) returned during the follow-up period for a visit that included Hemoglobin A1c (HbA1c) results. Intervention Integrated social medicine approach that includes food insecurity screening, nutrition education, and assistance accessing food resources as a standard-of-care practice designed to minimize disruptions in how patients and providers experience medical care. Measures HbA1c collected as part of a standard blood panel. Analysis Repeated-measure, mixed-effect linear regression models. Results There was a decrease in mean HbA1c (Δ = −0.22, P = 0.01) over the study period. The model examining change over time, glycemic control (GC), and food security status (F 1, 352 = 5.80, P = 0.02) indicated that among participants with poor GC (33.12%), food secure (FS) participants exhibited significantly greater levels of improvement than food insecure (FI) participants (Δ = −0.55, P = 0.04). Among participants with good GC, changes in HbA1c were not significantly different between FS and FI participants (Δ = 0.23, P = 0.21). Conclusion Providing nutrition education and food assistance improved HbA1c profiles among FS and FI participants, but FI participants may face social and structural challenges that require additional support from health care teams.