Environmental Issues of Equity & Access to Diabetes Care among the Sioux
Background: Type 2 diabetes is highly prevalent among American Indian populations (more than three times that of the general population). This study designed and tested a culturally sensitive intervention among the Sioux and Winnebago tribes. Focus groups identified cultural constructs of type 2 diabetes which pointed to illness beliefs that inhibited healthcare usage. Environmentally based barriers were also identified.
Methods: Adult American Indians (324) residing on the Yankton, Rosebud, Pine Ridge and Winnebago reservations and diagnosed with type 2 diabetes were recruited to participate in the experimentally-designed study. Focus groups provided a window into the cultural constructs of illness and barriers to care. An intervention was designed consisting of diabetes education delivered via storytelling and self-empowering Talking Circles sessions. Grounded Theory methods identified environmental issues of equity and access to diabetes care. Descriptive statistics and chi-square analysis examined the impact of the intervention.
Results: Environmental factors that inhibited access and equity to care included isolation, rural reservation roads, poor food access, sedentary lifestyles and illness beliefs stemming from historical trauma and cultural beliefs. The intervention proved statistically significant in increasing diabetes knowledge and self-help behaviors, however, many environmental barriers remain.
Implications: Improved access to health education and to healthcare services must consider solutions that will respond to special population needs. Equity in health education and health services must start at the level of the targeted vulnerable population and take into consideration long-held beliefs and lifestyles that inhibit diabetes prevention and control. Equal access to educational information healthcare services is often lacking among vulnerable populations.