Introduction
Diabetes mellitus is one of the most common diseases in the USA, which has a high prevalence and leads to serious health complications. In the USA alone, more than 30 million people have diabetes (“National diabetes statistics report, 2017,” n.d.). What makes the situation more aggravating is the fact that nearly 24% of diabetes cases remain undiagnosed. Numerous measures are taken by the healthcare system and government to reduce the morbidity of diabetes. However, not all communities have equal access to quality health care and self-management programs. Specifically, low-income populations are much more likely to have undiagnosed or unmanaged diabetes than middle- or high-income ones. The level of education and ethnicity also serve as factors increasing the likelihood of diabetes (“National diabetes statistics report, 2017,” n.d.). The present paper offers a review of literature on the major reasons for diabetes prevalence in low-income communities. Poor access to healthy food, poverty, pregnancy, and insufficient response to self-management interventions are the most common causes of the disease’s prevalence in the target population.
Low-Income Population’s Access to Healthy Foods
Research on low-income communities’ access to healthful foods has been the focus of investigation in Cohen et al.’s (2017), Evans et al.’s (2015), and Gittelson and Trude’s (2017) studies. Obesity is one of the major diabetes triggers (“National diabetes statistics report, 2017,” n.d.). Hence, managing one’s diet is a crucial step in alleviating the burden of the disease. However, according to scholars, underserved populations do not have proper access to healthy foods. Specifically, Evans et al. (2015) note that individuals with low income demonstrate a high level of knowledge and preference for a healthy diet. At the same time, as researchers remark, there are certain barriers to these people’s healthy food shopping behaviors. These obstacles include the unaffordability of purchasing healthful products, low quality of the available healthy foods, insufficient geographic access to such products, and a generally poor quality of stores where the community buys food products (Evans et al., 2017). Scholars conclude that opening new supermarkets with affordable prices could significantly increase the tendency to eat healthy foods and, as a result, reduce obesity among low-income populations. Such measures would positively affect diabetes prevalence in low-income populations.
Two other studies under analysis also focus on the target population’s access to healthful foods. Gittelson and Trude (2017) report that diet-related community trials have the potential to enhance low-income communities’ attitudes toward healthy food choices. Researchers note that such behaviors as food purchasing and preparation can improve if food environment interventions are implemented. However, Gittelson and Trude (2017) also emphasize the insufficient frequency of such projects in low-income communities. Thus, they recommend raising the number of initiatives at all levels in order to reduce the risk of diabetes in the target community. Cohen et al.’s (2017) research is similar to Gittelson and Trude’s (2017) one in that both studies focus on healthy food as a factor affecting obesity, one of the most negative diabetes triggers. Cohen et al. (2017) analyze the impact of the Double Up Food Bucks incentive program on low-income patients. Scholars emphasize the positive effect of such programs on obesity reduction. However, they also acknowledge the insufficient use of such incentives. Thus, the problem of access to healthy foods in the target population group is acute, which leads to a high prevalence of diabetes among low-income individuals.
Poverty and Low Affordability of Medicines
Another crucial aspect that aggravates diabetes prevalence in the selected population group is the decreased opportunity of obtaining medications. Articles by Chow et al. (2018) and Mendenhall, Kohrt, Norris, Ndetei, and Prabhakaran (2017) are concerned with this issue. Mendenhall et al. (2017) investigate the association between health system structures, cultural context, and socioeconomic conditions as a factor impacting one’s access to quality health care. Researchers remark that diabetes is one of the most severe global health problems, the treatment of which is contingent on one’s financial affordability. In addition, Mendenhall et al. (2017) have found that diabetes, as well as other non-communicable illnesses, is widely spread in low-income communities. Scholars suggest that the combination of physical (disease) and social (poverty) factors is detrimental and negatively influences the possibility of managing diabetes in such populations.
The second article in this dimension focuses on the availability and affordability of basic diabetes medications in countries with different levels of income. Chow et al. (2018) report that there exists an extensive gap between diabetes medicines’ affordability in low- and high-income communities. Researchers have focused their investigation on the availability of metformin and insulin, two of the most common diabetes prescriptions. Chow et al.’s (2018) analysis indicates a considerable difference in various communities’ access to these drugs. Particularly, metformin was available in 100% of the pharmacies under inspection in high-income countries, whereas it was only present in 64.7% of low-income countries’ drug stores. The availability rate of insulin in high-income countries constituted 93.8%, while in low-income states, it could be found only in 10.3% of pharmacies (Chow et al., 2018). Affordability of drugs also differed across populations: 0.7% high-income households could not afford metformin, and 2.8% could not afford insulin. Meanwhile, the numbers were considerably higher for low-income communities: 26.9% and 63%, respectively (Chow et al., 2018). The study shows that low-income communities lack both availability and affordability of diabetes drugs, which cannot but increase the disease’s prevalence.
Prevalence of Diabetes in Low-Income Pregnant Women
Among the research topics dedicated to diabetes prevalence among low-income populations, a significant place belongs to the studies analyzing pregnant women’s disposition towards the disease. Yee, McGuire, Taylor, Niznik, and Simon (2015; 2016) have dedicated two research studies to this aspect of the problem. Scholars note that there are numerous barriers to low-income pregnant women’s diabetes self-care. In their 2015 research, Yee et al. have found the following obstacles: the novelty of the disease, economic and social instability, nutrition problems, psychological stressors, the burden of diabetes management, and outcome expectation. Yee et al. (2015) remark that disease novelty has a negative effect on women’s self-efficacy due to the limited knowledge and inability to change behavior. The lack of economic and social stability decreases support resources. Low nutrition self-efficacy is related to an excessive amount of new information, high costs of healthy foods, and low motivation (Yee et al., 2015). Psychological obstacles and the burden of illness management also serve as negative factors for low-income pregnant women. Finally, it is hard for the target population group to realize the link between their self-management actions and positive outcomes.
In another study, Yee et al. (2016) analyze the problem of eliminated self-efficacy of low-income pregnant women to follow nutrition recommendations. Several types of restrictions related to this problem have been singled out: women experienced the fear of the unknown, they could not decode nutrition labels, and they encountered difficulty finding appropriate foods in the “setting of food insecurity” (Yee et al., 2016, p. 180). Other barriers included insufficient motivation, difficulty finding a balance between one’s taste preferences and recommended products, following a healthy eating plan, and accommodating the disease to social and family life (Yee et al., 2016). Findings of Yee et al.’s (2015; 2016) studies indicate the existence of severe barriers to low-income women’s diabetes management, which leads to the high prevalence of the disease.
Poor Effect of Interventions on the Target Population Group
Finally, there is one more topic of interest for researchers studying the prevalence of diabetes in low-income communities. Several articles have been dedicated to the analysis of interventions’ effect on low-income diabetes patients. Kangovi et al. (2018), Mayberry, Berg, Harper, and Osborn (2016), Nelson et al. (2015), and Nelson et al. (2017) have investigated a variety of support programs aimed at relieving the burden of diabetes in low-income patients. Research findings indicate some obstacles that hinder the target population group to benefit from interventions’ goals fully.
Mayberry et al. (2016) and Nelson et al. (2015) have analyzed the effect of mHealth application interventions on low-income individuals with diabetes. Both studies report an overall positive impact of such applications on patients’ disease management. However, Mayberry et al. (2016) and Nelson et al. (2015) emphasize that the implementation of such applications in low-income communities meets obstacles due to the target population’s low engagement and low health literacy. Mayberry et al. (2016) note that communication about diabetes can serve as a positive factor only if the patient is actively interested in using the app and if one has a support person to help them cope with their symptoms. Nelson et al. (2015) remark that low health literacy, which is typically pertinent to low-income individuals, prevents people from participating in medication adherence promotion interventions. Both studies demonstrate that low-income communities face challenges in the process of utilizing mHealth applications with the aim of decreasing the burden of diabetes.
The studies by Kangovi et al. (2018) and Nelson et al. (2017) reveal data on community health worker (CHW) support programs and their likelihood to engage low-income patients. Both researches indicate that CHWs’ participation in low-income population’s diabetes management can produce positive outcomes. However, Nelson et al. (2017) remark that there is no significant improvement in patients’ self-management upon CHW-delivered support. Kangovi et al. (2018) also report no enhancement in self-rated health. However, scholars have found that such interventions can reduce hospitalizations (Kangovi et al., 2018). The analysis of these studies allows concluding that CHW should encourage low-income populations to participate in interventions more actively and arrange follow-up meetings to make results more beneficial.
Conclusion
A review of literature makes it possible to make several conclusions on the reasons for the prevalence of diabetes in low-income communities. The most common barrier to improving the management of the disease in this population is poverty, which leads to the unaffordability and unavailability of medications. Another serious obstacle is obesity, the management of which is rather difficult in the target community. Further, low-income pregnant women face numerous challenges on the way to coping with diabetes, which both aggravates their symptoms and increases the likelihood of their children to have diabetes. Finally, the participation of low-income individuals in interventions is rather low, which leads to poor outcomes. All of these causes escalate the prevalence of diabetes in low-income communities.
References
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