An Action Research Approach to Examining Perceptions and Needs in Diabetes Care in a Community in Mexico Using the Innovative Care for Chronic Conditions Framework and Social Capital Theory

摘要

Background: While there has been a dramatic increase in the prevalence of diabetes in developing countries, such as Mexico, there is a critical need to better understand how the challenges that arise in shifting the focus from acute care to care for chronic conditions manifest at the level of patient care provision in the health care organization and community, especially in rural resource-poor communities. One step in this direction is the exploration of the potential that social capital may provide in improving our understanding of the relationships that exists among patients, health care providers and the broader community.Objectives: To examine the provision of health care for diabetes, as well as the beliefs, resources and relationships that exist among patients and families, health care teams and community partners that affect treatment for diabetes in a rural resource-poor community in Mexico.Methods: This study incorporated a qualitative action-research approach and data was collected via community asset mapping, surveys, semi-structured interviews and group discussions. Utilizing an action research model, the study procedures were iterative, whereby results from selected data collection techniques were used to inform subsequent iterations of data collection. Community resources were identified with key informant input and via community exploration, to record existing and potential diabetes-related resources. Surveys were administered to health care providers, patients and general community members. Semi-structured interviews and group discussion topics were informed by the Innovative Care for Chronic Conditions Framework as well as by prior data collection procedures such as the surveys and preceding interviews. The interviews and group discussions were conducted with health care providers, diabetic patients, and community leaders.Results: Community asset mapping revealed limited existence of health care resources available to the rural community in Mexico. Three salient themes emerged across health care providers, diabetic patients, and community leaders: (1) Cultural eating behaviors are important drivers in preventing and managing diabetes mellitus; (2) Diabetic patients are currently ill-prepared to adequately manage chronic conditions, such as chronic conditions; (3) Trust is an important facilitator and/or barrier for both patients and health care providers when searching for ways to enhance management of diabetes outside of the health care organization.Conclusion: An evidence-based understanding of the diabetes-related beliefs, current perceived performance of diabetes care provision, the availability of community resources and social capital can be used to leverage the health care in low-income communities where primary health services are limited in their availability and/or capacity. The informed construction of community-derived initiatives and interventions that integrate community resources and improve the social capital within the community can enhance the care for patients with diabetes by offering both alternative and complementary avenues of accessing care that supports long-term disease management.