Barriers to self-management of diabetes: a qualitative study among low-income minority diabetics.

OBJECTIVES Diabetes self-management is a key element in the overall management of diabetes. Identifying barriers to disease self-management is a critical step in achieving optimal health outcomes. Our goal was to explore patients' perceptions about barriers to self-management of diabetes that could possibly help explain poor health outcomes among minority patients. STUDY DESIGN Four focus groups were conducted among 31 predominately African American patients with diabetes who were enrolled in the Baltimore Cardiovascular Partnership Study, a NIH-funded multiyear prospective partnership study. The topic guide consisted of a series of open-ended questions about knowledge of current health status, medication use, continuity of care, blood glucose level and nutrition. RESULTS The focus groups confirmed that previously reported barriers to self-management persisted and identified new concerns that could be associated with poor health outcomes among minority patients with diabetes. Attitudes, perceptions and behaviors surrounding diabetes and self-management of the condition did vary across individuals, however, the variation appeared to reflect the individual's knowledge and opinions rather than patient's age, sex, or culture. The primary barrier to diabetes self-management resulted from lack of knowledge of target blood glucose and blood pressure. Several participants found some of the health information to be quite confusing. CONCLUSIONS Diabetes is a major public health concern and the lack of awareness of target blood glucose and blood pressure further complicates the problem. The limited health literacy seen in this study could help explain several of the barriers to self-management. The barriers to self-management identified in this qualitative study are amenable to intervention that could improve health outcomes.