Investigating the experience of diabetes care in a First Nations community on the Canadian prairies

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Hayden, Leigh Grace
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Type 2 diabetes mellitus is a serious chronic disease that First Nations Canadians are three to five times more likely to develop than people in the general Canadian population. Filst Nations people with diabetes are also more likely to develop diabetes complications than people with diabetes in the general population. This may in part reflect the quality of care people in some First Nations communities receive. The purpose of this research project was to explore the experience of diabetes care among people with diabetes, their family members, and practitioners in a small, isolated First Nations community on the Canadian prairies who had voiced concern about the diabetes care available to the community. Through participant observation and semi-structured interviews with health care providers, administrators, people with diabetes, and their family members I elicited and explored the opinions and experiences of diabetes care in the community. Applying Kleinman's Explanatory Models theory, I found that people with diabetes and their practitioners varied considerably in their accounts of (1) the role of pharmacological treatment in diabetes, (2) the emotional impact of diabetes, and (3) expectations of the patient-practitioner relationship. According to the Explanatory Models theory these differences can lead to dissatisfaction in care because the different parties fundamentally understand and relate to these areas of care differently, expressing different knowledge and expectations. I also found that factors outside of the clinical encounter such as issues with obtaining referrals, care at a distance, and care in a non First Nations community impacted diabetes care. Thus sharing patients' understandings of diabetes care with physicians in conjunction with addressing structural barriers to care may lead to better diabetes care and may ultimately impact diabetes outcomes.