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International journal for equity in health
08 24, 2023;22 (1): 163.

Voices of those living with type 2 diabetes in Belize: barriers to care before and during the COVID-19 pandemic.

Lindsay P Allen, Lucia Ellis, Christophe Engleton, Valerie Lynette Valerio, Andrew R Hatala
Author Information
  1. Lindsay P Allen: Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, 221 Human Ecology Bldg, Winnipeg, MB, R3T 2N2, Canada.
  2. Lucia Ellis: Belize Diabetes Association, Belize City, Belize.
  3. Christophe Engleton: Belize Diabetes Association, Belize City, Belize.
  4. Valerie Lynette Valerio: Belize Diabetes Association, Belize City, Belize.
  5. Andrew R Hatala: Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, 221 Human Ecology Bldg, Winnipeg, MB, R3T 2N2, Canada. andrew.hatala@umanitoba.ca.
PMID: 37620814 DOI: 10.1186/s12939-023-01987-3

Abstract

Belize has the highest national prevalence of type 2 diabetes (T2D) of Central and South America, and fifth direst in the world. T2D is the leading cause of death in Belize, a country facing burdens of increasing prevalence with few resources. Since March of 2020, the COVID-19 pandemic has exacerbated the difficulties of those living with T2D in Belize. To address T2D issues in Belize, our interdisciplinary research team explored the barriers to care and self-management for adult patients with T2D in Belize prior to and during the COVID-19 pandemic.Research relationships between Canadian (ARH) and Belizean (LE) authors have been ongoing since 2016. Together we used a qualitative Constructivist Grounded Theory design generating knowledge through 35 semi-structured patient interviews, 25 key informant discussions, and participant observation with field notes between February 2020 to September 2021. We used Dedoose analysis software for a systematized thematic coding process, as well as iterative verification activities. Findings revealed several barriers to care and self-management, including: 1) the tiered health and social care system with major gaps in coverage; 2) the unfulfilled demand for accurate health information and innovative dissemination methods; and 3) the compounding of loss of community supports, physical exercise, and health services due to COVID-19 restrictions. In the post-pandemic period, it is necessary to invest in physical, nutritional, economic, and psychosocial health through organized activities adaptable to changeable public health restrictions. Recommendations for activities include sending patients informational and motivational text messages, providing recipes with accessibly sourced T2D foods, televising educational workshops, making online tools more accessible, and mobilising community and peer support networks.

Keywords

Barriers to care Belize COVID-19 Central and South America Type 2 diabetes

References

  1. Diabet Med. 2021 Mar;38(3):e14469 [PMID: 33274489]
  2. Glob Public Health. 2013;8(9):1063-74 [PMID: 24028377]
  3. Diabetes Metab Syndr Obes. 2021 Oct 22;14:4335-4349 [PMID: 34712054]
  4. Qual Health Res. 2018 Oct;28(12):1871-1882 [PMID: 30066604]
  5. Diabetes. 2017 Jun;66(6):1432-1442 [PMID: 28533294]
  6. Sci Diabetes Self Manag Care. 2021 Oct;47(5):382-390 [PMID: 34610761]
  7. J Diabetes Sci Technol. 2008 May;2(3):509-17 [PMID: 19885219]
  8. Diabet Med. 2020 Jul;37(7):1146-1154 [PMID: 32392380]
  9. Health Equity. 2019 May 15;3(1):211-218 [PMID: 31289781]
  10. Qual Health Res. 2016 Nov;26(13):1753-1760 [PMID: 26613970]
  11. Diabet Med. 2021 Nov;38(11):e14665 [PMID: 34327749]
  12. Diabetes Educ. 2017 Feb;43(1):40-53 [PMID: 28118121]
  13. Afr J Prim Health Care Fam Med. 2017 Oct 17;9(1):e1-e9 [PMID: 29113442]
  14. PLoS One. 2023 Aug 3;18(8):e0289212 [PMID: 37535596]
  15. Ann N Y Acad Sci. 2015 Sep;1353:89-112 [PMID: 26250784]
  16. Cochrane Database Syst Rev. 2014 Sep 04;(9):CD006424 [PMID: 25188210]
  17. Diabet Med. 2012 May;29(5):654-61 [PMID: 21992512]
  18. Health Equity. 2020 May 18;4(1):211-217 [PMID: 32440618]
  19. BMC Health Serv Res. 2017 Feb 28;17(1):171 [PMID: 28245810]
  20. J Relig Health. 2013 Dec;52(4):1147-61 [PMID: 22083464]
  21. Sci Diabetes Self Manag Care. 2021 Aug;47(4):290-301 [PMID: 34318725]
  22. Curr Dev Nutr. 2018 Dec 05;3(Suppl 2):63-68 [PMID: 31453429]
  23. J Diabetes. 2018 Apr;10(4):344-345 [PMID: 29206347]
  24. Workplace Health Saf. 2014 Nov;62(11):444-6 [PMID: 25373027]
  25. Med Anthropol. 2014;33(2):92-108 [PMID: 24512380]
  26. Hisp Health Care Int. 2019 Dec;17(4):162-171 [PMID: 31096784]
  27. Diabet Med. 2013 Jul;30(7):767-77 [PMID: 23711019]

Grants

  1. FRN 130797/CIHR

MeSH Term

Adult
Humans
COVID-19
Belize
Canada
Diabetes Mellitus, Type 2
Pandemics
Health Services Accessibility
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 1

Word Cloud

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