Persistent Barriers and Strategic Practices

The Issue:

Open communication is an important component in diabetes care. As the organizing principle underlying diabetes management shifts away from standardized measures of adherence toward a patient-centered approach, understanding the barriers to care and the practices affirming care is important.

This study explores everyday barriers and practice of low-income patients managing their diabetes.

Key Findings

  • Persistent barriers include competing demands, cycles of food availability, and time, money, and the temptation of unhealthy foods.

  • Strategic practices included reducing food intake as opposed to revising overall eating habits and reducing the number of blood glucose levels readings to decrease costs associated with medical materials.

  • This study suggests that health outcomes may not always represent the time a patient invests in his or her health. The patients in this study had poor health outcomes, but the interviews suggest they were still working hard and spending time managing their disease.


The clinical encounter provides an important opportunity for the patient and health care provider to work together to address the barriers to health and the strategic practices diabetes patients face. Health care providers should incorporate the everyday socioeconomic environment of patients when providing recommendations to diabetes patients.

About the Study:

This study uses qualitative data collected as part of a larger mixed-methods research study. The current study included 20 interviews of patients with type 2 diabetes recruited from three academic primary care practices and one community-based safety-net clinic in Los Angeles, California. Data was collected between August 2008 and November 2009.