title: Diabetes care provision: barriers, enablers and service needs of young adults with Type 1 diabetes from a region of social disadvantage.
abstract: OBJECTIVE
  To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region.
  
  
  METHODS
  A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire).
  
  
  RESULTS
  Eighty-six (24%) responses were received [55 (64%) female; mean ± sd age 24 ± 4 years; diabetes duration 12 ± 7 years; HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety.
  
  
  CONCLUSIONS
  Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.
authors: Diabetes Unit, Southern Health, Melbourne, Australia.
authors: K J
authors: KJ
authors: Kibbey
authors: J
authors: J
authors: Speight
authors: J L A
authors: JL
authors: Wong
authors: L A
authors: LA
authors: Smith
authors: H J
authors: HJ
authors: Teede
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014186:Transportation; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin