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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Ahola AJ, Groop PH (2013) Barriers to self-management of diabetes. Diabet Med 30(4):413–420. https://doi.org/10.1111/dme.12105
Alexander A, Florez H, Ladera N (2017) Hyperglycemia and dyslipidemia of Isabela, Galápagos, Ecuador: a pilot study of cardiovascular risk factors in an Isolated Island community. Diabetes Res Clin Pract 130:108–112. https://doi.org/10.1016/j.diabres.2017.05.015
American Diabetes Association (2017) Lifestyle management. Diabetes Care 40(Supplement 1):S33–S43. https://doi.org/10.2337/dc17-S007
American Diabetes Association (2018) Introduction: standards of medical care in diabetes-2018. Diabetes Care 41(Suppl 1):S1–S2. https://doi.org/10.2337/dc18-Sint01
Arredondo A (2014) Type 2 diabetes and health care costs in Latin America: exploring the need for greater preventive medicine. BMC Med 12:136. https://doi.org/10.1186/s12916-014-0136-z
Atun R, de Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P et al (2015) Health-system reform and universal health coverage in Latin America. Lancet 385(9974):1230–1247. https://doi.org/10.1016/S0140-6736(14)61646-9
Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR et al (2010) Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 33(12):e147–e167. https://doi.org/10.2337/dc10-9990
Cotlear D, Gómez-Dantés O, Knaul F, Atun R, Barreto ICHC, Cetrángolo O et al (2015) Overcoming social segregation in health care in Latin America. Lancet 385(9974):1248–1259. https://doi.org/10.1016/S0140-6736(14)61647-0
Dao J, Spooner C, Lo W, Harris MF (2019) Factors influencing self-management in patients with type 2 diabetes in general practice: a qualitative study. Aust J Prim Health 25(2):176–184. https://doi.org/10.1071/PY18095
Eckhardt M, Carlfjord S, Faresjö T, Crespo-Burgos A, Forsberg BC, Falk M (2019) Universal health coverage in marginalized populations: a qualitative evaluation of a health reform implementation in rural Ecuador. Inquiry 56:46958019880699. https://doi.org/10.1177/0046958019880699
Fisher EB, Ballesteros J, Bhushan N, Coufal MM, Kowitt SD, McDonough AM et al (2015) Key features of peer support in chronic disease prevention and management. Health Aff (Project Hope) 34(9):1523–1530. https://doi.org/10.1377/hlthaff.2015.0365
Fort MP, Alvarado-Molina N, Peña L, Mendoza Montano C, Murrillo S, Martínez H (2013) Barriers and facilitating factors for disease self-management: a qualitative analysis of perceptions of patients receiving care for type 2 diabetes and/or hypertension in San José, Costa Rica and Tuxtla Gutiérrez, Mexico. BMC Fam Pract 14:131. https://doi.org/10.1186/1471-2296-14-131
Frenk J, Gómez-Dantés O (2018) Health systems in Latin America: the search for universal health coverage. Arch Med Res 49(2):79–83. https://doi.org/10.1016/j.arcmed.2018.06.002
Galapagos Conservancy, Inc. (2020) San Cristóbal. Retrieved December 4, 2019, from https://www.galapagos.org/about_galapagos/about-galapagos/the-islands/san-cristobal/
Gonzalez Rodriguez H, Wallace DD, Barrington C (2018) Contextualizing experiences of diabetes-related stress in rural Dominican Republic. Qual Health Res 29(6):857–867. https://doi.org/10.1177/1049732318807207
Hänninen J, Takala J, Keinänen-Kiukaanniemi S (2001) Good continuity of care may improve quality of life in type 2 diabetes. Diabetes Res Clin Pract 51(1):21–27. https://doi.org/10.1016/s0168-8227(00)00198-4
IESS (2019a) Prestaciones y Beneficios – IESS. Retrieved August 15, 2020, from https://www.iess.gob.ec/en/web/afiliacion-voluntaria/prestaciones-y-beneficios3
IESS (2019b) Seguro Campesino – IESS. Retrieved August 15, 2020, from https://www.iess.gob.ec/es/seguro-campesino
Instituto Nacional de Estadadística y Censos (2010) Población y Demografía: Galapagos y San Cristobal. Retrieved April 4, 2020, from https://www.ecuadorencifras.gob.ec/censo-de-poblacion-y-vivienda/
Instituto Nacional de Estadadística y Censos (2015) Análisis de resultados definitivos Censo de Población y Vivienda Galápagos 2015. Instituto Nacional de Estadadística y Censos, Quito
Koetsenruijter J, van Eikelenboom N, van Lieshout J, Vassilev I, Lionis C, Todorova E et al (2016) Social support and self-management capabilities in diabetes patients: an international observational study. Patient Educ Couns 99(4):638–643. https://doi.org/10.1016/j.pec.2015.10.029
Leibowitz KA, Hardebeck EJ, Goyer JP, Crum AJ (2018) Physician assurance reduces patient symptoms in US adults: an experimental study. J Gen Intern Med 33(12):2051–2052. https://doi.org/10.1007/s11606-018-4627-z
Lucio R, Villacrés N, Henríquez R (2011) The health system of Ecuador. Salud Publica Mex 53(Suppl 2):s177–s187
Lustman A, Comaneshter D, Vinker S (2016) Interpersonal continuity of care and type two diabetes. Prim Care Diabetes 10(3):165–170. https://doi.org/10.1016/j.pcd.2015.10.001
Nam S, Chesla C, Stotts NA, Kroon L, Janson SL (2011) Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract 93(1):1–9. https://doi.org/10.1016/j.diabres.2011.02.002
Ong SE, Koh JJK, Toh S-AES, Chia KS, Balabanova D, McKee M et al (2018) Assessing the influence of health systems on type 2 diabetes mellitus awareness, treatment, adherence, and control: a systematic review. PLoS One 13(3):e0195086. https://doi.org/10.1371/journal.pone.0195086
Orces CH, Lorenzo C (2018) Prevalence of prediabetes and diabetes among older adults in Ecuador: analysis of the SABE survey. Diabetes Metab Syndr 12(2):147–153. https://doi.org/10.1016/j.dsx.2017.12.002
Pan American Health Organization (2017) Health in the Americas: Ecuador overall context. Retrieved December 4, 2019, from https://www.paho.org/salud-en-las-americas-2017/?p=4272
Pincus T, Holt N, Vogel S, Underwood M, Savage R, Walsh DA, Taylor SJC (2013) Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. Pain 154(11):2407–2416. https://doi.org/10.1016/j.pain.2013.07.019
Ross SA (2013) Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes. Am J Med 126(9 Suppl 1):S38–S48. https://doi.org/10.1016/j.amjmed.2013.06.012
Tufton N, Chowdhury T (2015) Prevalence of diabetes on Santa Cruz island in Galapagos Archipelago. Prev Chronic Dis 12:E94. https://doi.org/10.5888/pcd12.150108
Wallace DD, Gonzalez Rodriguez H, Walker E, Dethlefs H, Dowd RA, Filipi L, Barrington C (2019) Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic. Glob Public Health 14(1):135–146. https://doi.org/10.1080/17441692.2018.1444782
Whittemore R, Vilar-Compte M, De La Cerda S, Marron D, Conover R, Delvy R et al (2019) Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study. Int J Equity Health 18(1):133. https://doi.org/10.1186/s12939-019-1035-x
Wingert A, Johnson N, Melton S (2015) Understanding stress among adults diagnosed with type 2 diabetes at a younger age. PLAID 1(1). https://doi.org/10.17125/plaid.2015.8
World Health Organization (2016) Diabetes country profiles 2016. Retrieved January 15, 2018, from http://www.who.int/diabetes/country-profiles/en/
Yunga JC (2014) Anuario de Estadística de Salud: Recursos y Actividades 2014. Instituto Nacional de Estadistica y Censos. Retrieved from https://www.ecuadorencifras.gob.ec/documentos/web-inec/Estadisticas_Sociales/Recursos_Actividades_de_Salud/Publicaciones/Anuario_Rec_Act_Salud_2014.pdf
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Davis, C.H., Lara Marchena, P., Gonzalez Rodriguez, H., Barrington, C. (2022). “You Have to Eat What There Is”: Barriers to Effective Self-Management of Type 2 Diabetes in San Cristóbal, Galápagos. In: Thompson, A.L., Ochoa-Herrera, V., Teran, E. (eds) Water, Food and Human Health in the Galapagos, Ecuador. Social and Ecological Interactions in the Galapagos Islands. Springer, Cham. https://doi.org/10.1007/978-3-030-92411-9_15
Download citation
DOI: https://doi.org/10.1007/978-3-030-92411-9_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-92410-2
Online ISBN: 978-3-030-92411-9
eBook Packages: Earth and Environmental ScienceEarth and Environmental Science (R0)