title: 'It still leaves me sixty dollars out of pocket': experiences of diabetes medical care among low-income earners in Perth.
abstract: Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community.
authors: Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors: Beatriz
authors: B
authors: Cuesta-Briand
authors: National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors: Sherry
authors: S
authors: Saggers
authors: Centre of Excellence for Science, Seafood and Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors: Alexandra
authors: A
authors: McManus
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001315:Australia; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006303:Health Services, Indigenous / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics* / Q000379:methods*