Developing a framework to improve health care utilization among those with Type 2 diabetes living in slums

Abstract

Abstract Introduction:Due to slum dwellers' deprivation, they are more likely to develop Type 2 Diabetes (T2D) and its complications. Objective: This study was conducted to formulate a framework for promotion of health services utilization among patients with type 2 diabetes living in slums. Methods: This study was multi-methods (review, quantitative and qualitative). In the systematic review part, the identifications of barriers and facilitators for type 2 diabetes management among was conducted. The method proposed by Thomas and Harden was used for data analysis. In the quantitative part, using a questionnaire, the extent and factors influencing health care utilization, and related dimensions were obtained. In the qualitative part, a content analysis was conducted among 23 service providers. Data analysis was done using colaizzi's method. In the next step, based on the findings of 3 parts the initial framework was developed. Results: In the review study, topics related to individual factors, health system and context were branched out. In the results section, it was shown that 3.30% to 53% of people utilised from health services. 85.5% of patients needed to higher coverage of costs by insurance organizations, 68% needed to receive financial support for providing medicine and 48.5% needed to free and accesible sports equipment for utilization of health services. In the qualitative study, three themes including health system related factors, coverage and contextual factors were extracted. Framework consists of four areas, including individual, social, health system and context. Conclusions: Policy makers and managers of health sector and related organizations should consider increasing financial support, providing continuous and detailed education to patients and their families, increasing coverage of costs by insurance, and improving the processes of services delivery in the health system, as well as improving the infrastructure in slum areas until those with type 2 diabetes could appropriately utilize of health services. Keywords: Type Diabetes, Slum-Dwellers, Utilization, Unmet needs, Compliance to treatment, Diabetes Management