RT Journal Article
SR Electronic
T1 The challenges of managing diabetes while homeless: a qualitative study using photovoice methodology
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1034
OP E1041
DO 10.1503/cmaj.202537
VO 193
IS 27
A1 Rachel B. Campbell
A1 Matthew Larsen
A1 Anna DiGiandomenico
A1 Marleane A. Davidson
A1 Gillian L. Booth
A1 Stephen W. Hwang
A1 Kerry A. McBrien
A1 David J.T. Campbell
YR 2021
UL http://www.cmaj.ca/content/193/27/E1034.abstract
AB BACKGROUND: Minimal consideration has been given to understanding the challenges of managing diabetes while homeless from the perspective of those with lived or living experience. We used a community-based participatory approach to explore these challenges.METHODS: We recruited coresearchers with experiential knowledge of both homelessness and diabetes. Lead researchers conducted research training and facilitated research development by coresearchers. Coresearchers collectively chose to use photovoice methodology to illustrate the challenges of accessing healthy food while homeless and to explore how homelessness more broadly affects diabetes management. After training in photography technique and ethics, coresearchers took photos to address these objectives and created accompanying narratives using photo elicitation techniques. Lead researchers analyzed photos and narratives, and extracted themes, refined through group discussion.RESULTS: The 8 coresearchers had type 2 diabetes (diagnosed 18 months to 23 years previously) and had experienced homelessness for periods ranging from 8 months to 12 years. We identified 4 themes from the 17 photos and narratives they produced. Homelessness imposed major demands on emotional and mental health, impairing the ability of those affected to focus on diabetes self-management. Foods provided in shelters were often nutritionally poor or unpalatable. Obtaining housing facilitated diabetes management through stability and autonomy, but cost and lack of knowledge posed challenges to healthy food preparation. Homelessness also presented challenges to accessing diabetes care professionals and prescription medications.INTERPRETATION: The images and narratives provide a powerful firsthand, in-depth account of the challenges faced by people trying to manage diabetes while homeless. Understanding these challenges is the first step in enabling providers and policy-makers to meet the needs of this population.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.210963