Disadvantage and disease: experience of type 2 diabetes among low income earners in Perth, Western Australia

Abstract

Diabetes prevalence is increasing in Australia and worldwide. An estimated four per cent of the Australian population in 2007–08 had been diagnosed with diabetes, and figures show stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups.This qualitative study explored the impact of socio-economic disadvantage on the experience of type 2 diabetes in Perth, Western Australia. The objectives of the study were to: explore the attitudes and experiences of persons at socio-economic disadvantage living with type 2 diabetes with respect to living with and self-managing their disease, the medical management of their disease, and seeking access to healthcare services; analyse participants’ perception of the quality of care received, and how those perceptions are formed; and elicit priorities for the effective management of type 2 diabetes from the perspective of disadvantaged health consumers.The study was positioned within a social justice and health equity framework, with a strong emphasis on the social determinants of health. The study drew from an existing conceptual framework on the relationship between socio-economic position and health among persons with type 2 diabetes to explore the pathways of disadvantage leading to poorer health outcomes.Data were collected through focus groups and semi-structured interviews held from October 2008 to November 2009. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from areas with high indices of disadvantage in the Perth metropolitan area. Deductive data analysis identified categories from the conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes.The study unveiled multilevel pathways through which socio-economic status influences diabetes health outcomes in a sample of low income earners. A modified framework is presented which highlights the main pathways of disadvantage based on the study results, and emphasizes the complex, interweaving factors shaping the structural and psychosocial environment in which disadvantaged individuals experience their disease.Study results suggest that the circumstances in which the experience of disease of disadvantaged populations are embedded need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.