Abstract
Objectives To understand patients’ experiences with
diabetes care during the COVID-19
pandemic, with
an emphasis on rural, medically underserved, and/or
minoritised racial and ethnic groups in the Midwestern
USA.
Design Community-engaged,
semi-structured
interviews
were conducted by medical student researchers trained
in qualitative interviewing. Transcripts were prepared
and coded in the language in which the interview was
conducted (English or Spanish). Thematic analysis was
conducted, and data saturation was achieved.
Setting The study was conducted in communities in
Eastern and Western Iowa.
Participants Adults with diabetes (n=20) who were fluent
in conversational English or Spanish were interviewed.
One-third
of participants were residents of areas
designated as federal primary healthcare professional
shortage areas and/or medically underserved areas, and
more than half were recruited from medical clinics that
offer care at no cost.
Results Themes across both English and Spanish
transcripts included: (1) perspectives of diabetes, care
providers and care management; (2) challenges and
barriers affecting diabetes care; and (3) participant
feedback and recommendations. Participants reported
major constraints related to provider availability, costs of
care, access to nutrition counselling and mental health
concerns associated with diabetes care during the
pandemic. Participants also reported a lack of shared
decision-making
regarding some aspects of care, including
amputation. Finally, participants recognised systems-level
challenges that affected both patients and providers and
expressed a preference for proactive collaboration with
healthcare teams.
Conclusions These findings support enhanced
engagement of rural, medically underserved and
minoritised groups as stakeholders in diabetes care,
diabetes research and diabetes provider education.