Impacts of Poor Access to Diabetes Self-Management Educational Programs on Low-Income Earners, Race, and Ethnic Minority Groups

Quality healthcare is a multidimensional, complex, and intuitive concept that encompasses the provider’s cost, profitability and productivity, patient satisfaction, and client satisfaction which encourages loyalty and sustains a competitive advantage among service providers. Poor access to diabetes self-management education programs is a prevailing challenge affecting low-income earners and racial and ethnic minorities in the community. The poor access to diabetes self-management educational programs adversely affects the quality of care, patient safety, and costs to the system and patient.
Diabetes self-management education (DSME) is a continuous process that equips participants with the prerequisite knowledge and skills for diabetes self-care. The program incorporates sustainable and pragmatic coping mechanisms addressing the patient’s behaviors, emotional needs, numeracy, societal beliefs and misconceptions, financial implications, social support, and health literacy. DSME provides adequate information and guidance on improving quality of life. Some daily key elements beneficial to patients include weight management, diet, monitoring glucose levels, appropriate medication, and physical exercises. Routine self-care activities reduce complications and attain the desired clinical outcomes. The DSME interventions in low-income populations have a low participation and retention rate. Mayberry et al. (2016) posit that low-income earners experience more stress triggers, exhibit lower self-care literacy, and awareness, and are likely to indulge in self-sabotaging activities such as unhealthy diets. The poor access to DSME is attributable to the physical environment and lack of adequate resources for low-income earners and ethnic minorities in the community. DSME significantly improves the quality of care, but poor access to such programs produces undesirable health outcomes.
Quality healthcare is a multidimensional concept that incorporates accuracy, competency, accessibility, confidentiality, equity, privacy, safety, and security. The core objective of healthcare systems is to provide quality care with minimal risks. Further, quality care enables maximum utilization of available resources. Low-income earners and ethnic minorities have low access to DSME, making them more susceptible to complications and untimely death. Misguided self-efficacy among low-income earners and race and ethnic minorities in the community inevitably contributes to poor decision-making.
In 2007, the cost of treating and managing diabetes was $174 billion, which should rise to $860 billion by 2030 (Brunisholz et al., 2014). The increasing healthcare expenditure budget is a growing concern for health economists. DSME is a pragmatic intervention that significantly lowers treatment costs while improving the quality of care. DSME has significantly reduced hospital admission and readmission rates (Powers et al., 2020). However, low-income earners experience difficulties with the increasing healthcare cost. Low-income earners cannot meet their basic needs effectively, and proper healthcare becomes a secondary need. Race and ethnic minorities face discrimination in the health care systems characterized by bureaucratic processes when applying for insurance policies or claims. According to previously conducted research, ethnic minorities in the community, such as Asian Americans and non-Hispanic Blacks, are more prone to diabetes than non-Hispanic whites. The racial disparity in healthcare outcomes among the ethnic minority in the community is more pronounced in the diagnostic and evaluation stages. Chen et al. (2014) investigated the magnitude of racial disparity in clinical care over ten years. The research findings indicate that psychosocial, environmental, and socioeconomic factors are the major factors causing the discrepancy. Further, racial discrimination inhibits access to specialized treatment and professionals. On a macro scale, poor access to DSME continuously affects the financial status of a low-income earner and race and ethnic minority due to the rising complications and need for specialized treatment.
Government Policies and their Impacts
Various regulatory bodies formulate and implement numerous state board nursing practices and government policies. State board nursing practices ensure standard nursing practices are adhered to, thus promoting safe nursing care. On the other hand, government policies provide a legal framework that facilitates service delivery and governs medical personnel’s code of conduct. One recently incorporated standard entails evaluating the population served (Beck et al., 2019). The standard requires service providers to assess their clientele and determine the approach used and delivery methods. The evaluation provides a basis for determining possible areas of improvement. The review of the population served addresses a critical shortcoming of DSME and the healthcare system, limited access. Diabetes is a chronic disease, with most of the population prone to the disease. However, few people have access to DSME and other treatment options.
The standard stipulates that providers should understand their targeted population’s needs and establish the appropriate classification, including age, literacy levels, sex, background, and ethnic background. The evaluation process is essential and identifies the factors limiting access to diabetes treatment and management. There exists a direct correlation between personal barriers and undesirable health outcomes. The individual barriers include cultural backgrounds, insurance challenges, and ignorance. The individual barriers undermine the quality of care and patient safety and considerably increase treatment and management costs.
The standards have propelled providers to incorporate modern technology that enhances service delivery and enriches patients’ quality of life. Additionally, the innovative solutions have provided numerous access platforms while providing personalized care to patients. Personalized care encourages patients’ engagement and retention rate. According to Cortez et al. (2017), conventional diabetes management techniques fail to curb the condition’s progressive nature. Therefore, individualized care helps providers understand the patient’s condition by evaluating the population served and offering appropriate remedies. The evaluation process assists in determining the proper empowerment programs that motivate patients.
Golden et al. (2017) argue that diabetes is a health inequity affecting ethnic and racial minority groups and low-income earners. The population health framework is an integral component of diabetes healthcare systems, beneficial in realizing desired health outcomes at a population level and addressing health inequities. Population health is a multi-level policy involving community health workers, service providers, health care systems, and patients’ decisions (Institute of Medicine et al., 2003). Population health assesses various health indicators or metrics influenced by economic status, cultural beliefs and practices, genetic makeup, patient’s history, and social support mechanism. The policy establishes standard procedures that ensure consistency of results. It is imperative to incorporate the evaluation of population-served policy and population health standards. The two policies effectively understand the patient’s needs and increase access to DSME.
Proposed Strategies
The significant factors to consider when assessing poor access to DSME are quality of care, patient safety, and cost implication. Community health workers (CHWs) provide critical care and support to patients. Enhancing the CHW and peer leaders (PL) participation in DSME ensures that patients’ access is guaranteed. Peer leaders are community members who share common characteristics with the targeted population. The proposed strategy builds trust between healthcare providers and patients and incorporates mandatory counseling sessions. Provider-patient trust is pertinent to better healthcare outcomes. However, research indicates a growing culture of mistrust propelled by patients’ perception of physicians’ competency, communication process, and interpersonal relationships (Lee et al., 2019). CHW and PL frequently interact with patients and form a long-lasting rapport based on mutual understanding and respect. The counseling session aims to understand the patient’s needs and challenges and maintain trust.
Further, the CHW assigned to individual patients should understand and relate to the patient’s cultural, financial, and social backgrounds. The strategy helps design appropriate solutions that align with the patient’s core beliefs. Research from Spenser et al. (2018) indicates that CHW and PL-led intervention improves consistency, improving the quality of care while ensuring patient safety.
Conventional disease treatment and management techniques are ineffective and drastically reduce efficiency. Quality healthcare requires awareness and prompt actions, and preventive measures. The advancement in internet technology, specifically social media platforms and email, facilitate fast and effective communication channels. The healthcare system should capitalize on internet-based platforms to create awareness and provide adequate information on various programs that enhance the quality of care. The proposed solution encompasses a transformative approach focusing on low-income earners and minority racial and ethnic groups. Although the diabetes prevalence rate in low-income earners and racial and ethnic minorities is higher, the number of insured persons or families is low (Simmons et al., 2019). The lack of an active insurance policy increases the out-of-pocket expenses incurred. Out-of-pocket expenses inflate health expenditures and deter most people from seeking quality healthcare. Thus, exposing the population to higher bankruptcy risks in case of a chronic medical condition or a complication. The proposed solution informs, educates, and encourages public participation. Online programs and campaigns enlighten internet users on insurance benefits, preventive measures, applicable remedies, and solutions.
Additionally, the proposed strategy encourages public participation in policy formulation, thus promoting inclusivity. Incorporating modern technology in healthcare systems facilitates broader coverage and rapid response to health-related issues. The proposed strategy improves the quality of care, mitigates risks and threats, reduces the cost to the system and individual, increases efficiency, and promotes better utilization of resources.
Available Resource for Comparison and Benchmarking
Continuous quality improvement is vital in assessing the performance, productivity, and effectiveness of healthcare systems and policies (Hughes, 2008). The assessment includes comparing two or more medical institutions based on the feedback offered by patients and other relevant personnel. The feedback provided is a reliable source of data that focuses on individual experiences. The Medicare website offers users a valuable platform to compare key performance indicators for various health organizations and medical practitioners. The website relies on a patient survey to generate ratings. The patient survey establishes the overall experience of individuals regarding the communication process, the provider’s readiness to help, clarity of instructions, the general condition of the facility and its environs, and the likelihood of recommending the facility.

References
Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., Cypress, M., Faulkner, P., Fischl, A. H., Francis, T., Kolb, L. E., Lavin-Tompkins, J. M., MacLeod, J., Maryniuk, M., Mensing, C., Orzeck, E. A., Pope, D. D., Pulizzi, J. L., Reed, A. A., Wang, J. (2019). 2017 national standards for diabetes Self-Management education and support. The Diabetes Educator, 46(1), 46–61. https://doi.org/10.1177/0145721719897952
Brunisholz, K., Briot, P., Hamilton, S., Joy, E., Lomax, M., Barton, N., Cunningham, R., Cannon, W., & Savitz, L. (2014). Diabetes self-management education improves the quality of care and clinical outcomes determined by a diabetes bundle measure. Journal of Multidisciplinary Healthcare, 533. https://doi.org/10.2147/jmdh.s69000
Chen, R., Cheadle, A., Johnson, D., & Duran, B. (2014). US trends in receipt of appropriate diabetes clinical and self-care from 2001 to 2010 and racial/ethnic disparities in care. The Diabetes Educator, 40(6), 756–766. https://doi.org/10.1177/0145721714546721
Cortez, D. N., Macedo, M. M. L., Souza, D. A. S., dos Santos, J. C., Afonso, G. S., Reis, I. A., & Torres, H. D. C. (2017). Evaluating the effectiveness of an empowerment program for self-care in type 2 diabetes: A cluster randomized trial. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-016-3937-5
Golden, S. H., Maruthur, N., Mathioudakis, N., Spanakis, E., Rubin, D., Zilbermint, M., & Hill-Briggs, F. (2017). The case for diabetes population health improvement: Evidence-Based programming for population outcomes in diabetes. Current Diabetes Reports, 17(7). https://doi.org/10.1007/s11892-017-0875-2
Hughes, R. G. (2008). Tools and strategies for quality improvement and patient safety. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (Vol. 3). Agency for Healthcare Research and Quality.
Institute of Medicine, Board on Health Promotion and Disease Prevention, & Committee on Assuring the Health of the Public in the 21st Century. (2003). The future of the public’s health in the 21st century (1st ed.). National Academies Press.
Lee, T. H., McGlynn, E. A., & Safran, D. G. (2019). A framework for increasing trust between patients and the organizations that care for them. JAMA, 321(6), 539. https://doi.org/10.1001/jama.2018.19186
Mayberry, L. S., Berg, C. A., Harper, K. J., & Osborn, C. Y. (2016). The design, usability, and feasibility of a Family-Focused diabetes Self-Care support mHealth intervention for diverse, Low-Income adults with type 2 diabetes. Journal of Diabetes Research, 2016, 1–13. https://doi.org/10.1155/2016/7586385
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists association. Diabetes Care, 43(7), 1636–1649. https://doi.org/10.2337/dci20-0023
Simmons, M., Bishu, K. G., Williams, J. S., Walker, R. J., Dawson, A. Z., & Egede, L. E. (2019). Racial and ethnic differences in Out-of-Pocket expenses among adults with diabetes. Journal of the National Medical Association, 111(1), 28–36. https://doi.org/10.1016/j.jnma.2018.04.004
Spencer, M. S., Kieffer, E. C., Sinco, B., Piatt, G., Palmisano, G., Hawkins, J., Lebron, A., Espitia, N., Tang, T., Funnell, M., & Heisler, M. (2018). Outcomes at 18 months from a community health worker and peer leader diabetes Self-Management program for Latino adults. Diabetes Care, 41(7), 1414–1422. https://doi.org/10.2337/dc17-0978