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Vulnerable individuals with diabetes navigating the health care system: A grounded theory study
The purpose of this constructivist study was to develop a substantive theory to explain the process of how vulnerable individuals with diabetes who are glycemically controlled navigate the health care system. Grounded theory was the research methodology. The grand tour question guiding the study was: how do vulnerable individuals with diabetes who are glycemically controlled navigate the health care system? For the purposes of the study, vulnerable individuals with diabetes were defined as belonging to at least two of the following groups identified by Shi and Stevens (2010) as vulnerable: predisposing factors (racial/ethnic minorities, elderly), enabling factors (uninsured, low income, unemployed), need factors (depression, chronically ill, disabled veterans). Eighteen of the twenty participants were served by community health centers in an urban setting. Glycemic control for the study was operationally defined as an A1c less than 8% at any time during the last year or "most" capillary blood glucose readings falling under 200 mg/dl. Twenty individuals were recruited into the study using purposive theoretical sampling. Nineteen of the participants were diagnosed with type 2 diabetes mellitus; one participant had type1 diabetes mellitus. Semi-structured interviews were completed and were audio taped. Data analysis was completed using the constant comparative technique. The emerging core category that explained the participants' main problem as well as its solution was Defying Gravity, Through Resilience. The sub-processes identified were: Being Told, Taking Ownership, Well-being as a Protective, Learning about Diabetes, Getting Health Care, Using the Safety Net, Seeking Care, Having Social Supports, Fearing Consequences, Thinking about Diabetes, Wanting to Live, and Facing Struggles. Results of the study have important implications for public health. Although access to care was good for most of the participants, lack of continuity of care, insufficient medical nutritional therapy, and financial/social challenges of food insecurity/ housing hardship were identified as struggles faced by the individuals. The emerging core category, Defying Gravity, Through Resilience, including all sub-processes, explains the participants' ability to achieve glycemic control.
Educational leadership|Health education
Sansom, Dorothy, "Vulnerable individuals with diabetes navigating the health care system: A grounded theory study" (2013). ETD collection for University of Nebraska - Lincoln. AAI3557237.