Barriers to health care utilization among patients with type 2 diabetes living in slums: a qualitative study from providers' perspective

Fawzieh Ghammari · Rahim Khodayari‐Zarnaq · Habib Jalilian · Masumeh Gholizadeh

11 citations0/0 files storedGlobal Health Research and Policy

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Public Health and Social Inequalities Diabetes Management and Education Urban and Rural Development Challenges

Abstract

BACKGROUND: Due to slum dwellers' deprivation, they are more likely to develop Type 2 Diabetes (T2D) and its complications. Type 2 Diabetes is a long-life disease that requires continuous health care utilization. One of the negative outcomes of slum-dwelling is health care underutilization. Therefore, this study aimed to understand barriers to health care utilization among those with T2D living in Tabriz slums, Iran, from the perspective of healthcare providers, in 2022. METHODS: A phenomenological approach was used in this study. Purposive sampling for conducting in-depth interviews was used to select 23 providers consisting of general practitioners, midwives, nutritionists, and public health experts. We conducted a content analysis using the 7 stages recommended by Colaizzi. We used four criteria recommended by Lincoln and Guba for ensuring the research's trustworthiness. RESULTS: Three main themes and 8 categories were developed. Three main themes are 1) health care provision system barriers, including four categories: lack of motivation, non-availability of facilities and doctors, poor relationship between patients and providers, and disruption in the process 2) coverage problems, including two categories: insurance inefficiency, and limited access, and 3) contextual barriers, including two categories: environmental problems, and socioeconomic barriers. CONCLUSIONS: Recommendations are presented in three levels to improve implementation. The health care system needs to modify the payment methods, Patients-providers relationship improvement, and increase the number of providers. Insurance organizations should consider sufficient coverage of costs for slum-dwellers with T2D and expand the benefits package for them. Government should consider infrastructure upgrading in slums to eliminate barriers related to slum-dwelling. Overall, health care utilization promotion needs intersection cooperation.

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1994Competing paradigms in qualitative research.2014Standards for Reporting Qualitative Research 2016How to plan and perform a qualitative study using content analysis 2002Two Decades of Developments in Qualitative Inquiry 1989Phenomenological Research Methods 2004A phenomenological hermeneutical method for researching lived experience 2015Autonomous adaptation to global environmental change in peri-urban settlements: Evidence of a growing culture of innovation and revitalisation in Mathare Valley Slums, Nairobi 2021Factors affecting the successful implementation of the referral system

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