“You Have to Eat What There Is”: Barriers to Effective Self-Management of Type 2 Diabetes in San Cristóbal, Galápagos

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Citation

Davis, C. Hunter; Marchena, Paulina Lara; Rodriguez, Humberto Gonzalez; & Barrington, Clare (2022). “You Have to Eat What There Is”: Barriers to Effective Self-Management of Type 2 Diabetes in San Cristóbal, Galápagos.. Thompson, Amanda L.; Ochoa-Herrera, Valeria; & Teran, Enrique (Eds.) (pp. 243-256). Cham, Switzerland: Springer International Publishing.

Abstract

Epidemiological shifts due to changes in global food production and dietary habits have led to an increased burden of chronic diseases, including type 2 diabetes, a condition that requires lifelong self-management. Factors at the individual, relational, and structural levels affect self-management. We conducted a formative, qualitative study to obtain a contextualized understanding of the lived experience of type 2 diabetes in San Cristóbal, in particular barriers to self-management and the role of the health system. We conducted semi-structured interviews with adults with type 2 diabetes (n = 20) and healthcare providers (n = 9). We identified four categories of healthcare engagement: (1) patients who were not actively receiving diabetes care (n = 1); (2) patients receiving care exclusively in Galapagos (n = 11); (3) patients receiving care exclusively on the mainland of Ecuador (n = 4); and (4) patients receiving care in both the mainland and Galapagos (n = 4). Using this framing to analyze patient narratives, we found three main barriers to diabetes self-management: (1) access to healthy, affordable foods; (2) medication worry and scarcity; and (3) access to quality care on the island. Patients described an interplay between their individual-level perceptions, knowledge and resources, and geographic isolation and limited access to specialized, quality care at the structural level. Patients’ ability to adhere to self-management recommendations requires improved patient-provider communication and structural reform of food distribution systems and healthcare services.

URL

https://doi.org/10.1007/978-3-030-92411-9_15

Reference Type

Book Section

Year Published

2022

Series Title

Social and Ecological Interactions in the Galapagos Islands (SESGI)

Author(s)

Davis, C. Hunter
Marchena, Paulina Lara
Rodriguez, Humberto Gonzalez
Barrington, Clare

Continent/Country

Galapagos

ORCiD

Barrington - 0000-0001-7802-4051