title: Diabetes education in the Appalachian region: providers' views.
abstract: BACKGROUND
  The aim of this study was to examine provider perceptions concerning the provision and accessibility of diabetes education, according to levels of economic distress and rurality throughout the US Appalachian region.
  
  
  METHODS
  A questionnaire regarding diabetes education resources was developed and mailed to all Federally Qualified Health Centers (FQHC), health departments, and known certified diabetes educators (CDEs) in the Appalachian region. Diabetes education was examined according to historical economic distress, distressed/at risk (DAR) versus not DAR (NDAR).
  
  
  RESULTS
  Diabetes education classes were offered equally across DAR and NDAR locations and most patients with diabetes had attended. The CDEs and physicians were less common in DAR compared with NDAR sites (adjusted odds ratios [aOR]=0.33 [0.13, 0.85] and 59.1 vs 166.9 per 100 000; p < 0.001). The DAR sites were more likely than NDAR sites to report transportation (aORs 2.19-4.94) as a problem for patients and insufficient staff (aOR=2.50 [1.20, 5.18]) as a problem for diabetes education programs.
  
  
  CONCLUSIONS
  Although DAR areas functioned with fewer health professionals than NDAR areas, many of the barriers to providing education affected patients and health professionals in both DAR and NDAR areas.
authors.affiliation: E365 Grover Center, Ohio University School of Nursing, Athens, Ohio 45701, USA. denham@ohio.edu
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Denham
authors.forename: Karen
authors.initials: K
authors.lastname: Remsburg
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D001061:Appalachian Region; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011361:Professional Competence; D011365:Professional Practice Location / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D055815:Young Adult