title: Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system.
abstract: OBJECTIVE
  This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management.
  
  
  METHODS
  Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York.
  
  
  RESULTS
  Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas.
  
  
  CONCLUSIONS
  Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management.
authors.affiliation: Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY 14203, USA. bvest@buffalo.edu
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Vest
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kahn
authors.forename: Andrew
authors.initials: A
authors.lastname: Danzo
authors.forename: Laurene
authors.initials: L
authors.lastname: Tumiel-Berhalter
authors.forename: Roseanne C
authors.initials: RC
authors.lastname: Schuster
authors.forename: Renée
authors.initials: R
authors.lastname: Karl
authors.forename: Robert
authors.initials: R
authors.lastname: Taylor
authors.forename: Kathryn
authors.initials: K
authors.lastname: Glaser
authors.forename: Alexandra
authors.initials: A
authors.lastname: Danakas
authors.forename: Chester H
authors.initials: CH
authors.lastname: Fox
mesh_terms: D015190:Blood Glucose Self-Monitoring / Q000191:economics; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D004645:Empathy; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009518:New York; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011203:Poverty; D036301:Qualitative Research; D012944:Social Support; D035502:Trust
keywords: Diabetes; low-income populations; qualitative; self-management; social capital