title: Structural barriers to coping with type 1 diabetes mellitus in Ghana: experiences of diabetic youth and their families.
abstract: OBJECTIVE
  To explore the structural barriers faced by families coping with type 1 diabetes mellitus (T1DM) in Ghana, and to provide insight for policy development.
  
  
  METHODS
  Qualitative study conducted with families with a child with T1DM, receiving care in the greater Accra area. Total of 17 individuals were interviewed using individual and dyadic approaches: 7 youth with T1DM, 9 parents of children with T1DM, and one medical doctor.
  
  
  RESULTS
  5 key barriers emerged from the data: primary care, schools, financial burden, lack of formal support, and access to information. Participants expressed concern over the misdiagnosis of T1DM at primary care facilities, resulting in some of the children going into a diabetic coma before receiving proper care. Children and parents noted discrimination and poor care at school. Financial burden was due to the high costs of medications and appliances needed for proper diabetes management. A lack of formal support was credited by participants to be the result of the lethargy of advocacy groups or resource centers. Finally, there was a lack of readily available and accessible information for children and parents on T1DM.
  
  
  CONCLUSIONS
  Awareness of T1DM needs to be increased, by incorporating lessons on recognition into already existing campaigns for type 2 diabetes mellitus (T2DM). Schools need to be more engaged with their responsibility for children with diabetes. Pressuring policy makers and pharmaceutical companies to make diabetes supplies more affordable and accessible could ease the financial burden. Social support networks need to be explored and strengthened. Study into the experiences of youth with T1DM in rural settings and other parts of Ghana, as well as, youth from low socioeconomic backgrounds is necessary.
authors: UBC Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada. jkratzer@chspr.ubc.ca
authors: J
authors: J
authors: Kratzer
mesh_terms: D022126:Access to Information; D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005260:Female; D005869:Ghana; D019538:Health Care Surveys; D006268:Health Facilities / Q000600:supply & distribution; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011320:Primary Health Care; D036301:Qualitative Research; D012572:School Health Services; D012944:Social Support; D055815:Young Adult
keywords: Ghana; children; families; structural obstacles; type 1 diabetes mellitus
references: Diabetes Care. 2004 May;27(5):1047-53
references: 15111519
references: Diabetes Res Clin Pract. 1998 Nov;42(2):123-30
references: 9886749
references: Diabetes Res Clin Pract. 2002 Jun;56(3):197-205
references: 11947967
references: J Health Psychol. 2004 Mar;9(2):295-309
references: 15018729
references: BMJ. 2005 Oct 1;331(7519):737
references: 16195290
references: Diabetes Care. 2005 Sep;28(9):2130-5
references: 16123478
references: Pediatr Endocrinol Rev. 2007 Dec;5(2):656-65
references: 18084160
references: Genet Soc Gen Psychol Monogr. 1994 Aug;120(3):311-26
references: 7926695
references: Sociol Health Illn. 1982 Jul;4(2):167-82
references: 10260456
references: Diabetes Res Clin Pract. 2000 Aug;49(2-3):149-57
references: 10963827
references: J Health Psychol. 2003 Sep;8(5):557-72
references: 19177717