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Inequalities in the Ability for People with Type 2 Diabetes and Pre-Diabetes to Adapt to the Reduction in In-Person Health Support and Increased Use of Digital Support During the Covid-19 Pandemic and Beyond: A Qualitative Study
ABSTRACT
Background:
The COVID-19 pandemic created unprecedented challenges for people with Type 2 Diabetes (T2D) to access in-person healthcare support. Primary care teams accelerated plans to implement Digital Health Technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and pre-diabetes adjusted to these changes.
Objective:
This study aimed to explore how people with T2D and pre-diabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic.
Methods:
A purposive sample of people with T2D and pre-diabetes were recruited by text message from primary care practices that served low-income areas. Semi-structured interviews were conducted by phone or videocall, data were analysed thematically using a hybrid inductive and deductive approach.
Results:
A diverse sample of 30 participants were interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge accessing support by rationing or delaying seeking support, or proactively requested appointments. Barriers to accessing healthcare support were associated with issues using the total triage system, a passive interaction style with healthcare services, or being diagnosed with pre-diabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity use DHTs caused by lower digital skills, fewer financial resources, and a lack of support to use the tools.
Conclusions:
Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs, lead to unequal possibilities for people with T2D and diabetes to self-care and receive care during the COVID pandemic. These issues can be addressed by proactive arrangement of regular check-ups by primary care services and improving capacity for people with lower digital skills to engage with DHTs. Clinical Trial: Not Applicable
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