Table 1—

The barriers-to-care groups and their definitions (adapted from ref. 5)

Barrier to careDescription
Psychological
    Western health beliefBelieve science/professionals should find a cure/do more
    Spiritual health beliefBelieve cause/cure should be sought spiritually/within
    Alternative health beliefPrefers to use alternative health models/treatments
    Public health beliefBelieves the public should bear more financial responsibility for health care
    Self-factors
MotivationPsychological: motivation, attitudes, laziness, denial
Self-efficacyNo confidence, external locus of control, low self-efficacy
    No symptom cueNo physical symptoms
    Priority settingOthers’ needs have priority over own (e.g., children, elders)
    Negative perceptions of timeNot enough time (education provided too quickly)
    EmotionalFear, shame, emotional anxiety, worry, lack of hope
    PrecontemplativeStrictness of regime, giving up things I enjoy
Educational
    Low diabetes knowledgeLacks general/specific diabetes knowledge
    Low knowledge of serviceUnaware of services available
    Educational (in general)*
Internal physical
    Self-factors/other health conditionsDiabetes (e.g., amputation) and non-diabetes related (e.g., arthritis)
    Physical effects of treatmentPain of glucose monitoring, drug side-effects
    Obesity*Being overweight/obese already
External physical
    Personal financeIncome in relation to costs
    Service/physical accessTransportation, wheelchair entry
    Limited range of servicesTiming of format of services (e.g., evening clinics, home visits)
    Appointment system/staffing levelsInsufficient staffing for adequate service
    Lack of community-based servicesNo local clinic that is identified as own
    Unhelpful health professional in pastPast encounter with health professional leading to conflict or without expected communication or clinical expertise
    Information management*Includes continuing professional education, research, audit
    Diabetes epidemic*Increasing numbers with diabetes or its complications will increase demand on services
Psychosocial
    Unsatisfactory/inappropriate diabetes care or educationWrong information provided or information provided in inappropriate way
    Group pressurePressure from others not to adhere to advice
    PrejudiceImpression of discriminatory practice due to diabetes or for other reasons
    Lack of public awareness of diabetesOthers behave without adequate knowledge or acceptance of diabetes
    Lack of family supportFamily consumes diabetic patient’s food, resists change of lifestyle
    Family demandsPressure to spend time/money on the family rather than their diabetes care
    Unsupportive macroenvironmentFeeling of lack of support in the community, e.g., access to low-fat foods
    CommunicationLanguage differences (translation)
    Inappropriate cultural messagesAttitude, ethnicity of workers, appropriateness of communication
  • *

    * New barriers identified in this study.