title: Persistent barriers and strategic practices: why (asking about) the everyday matters in diabetes care.
abstract: The purpose of this study was to explore the everyday barriers to and practices of low-income patients managing their diabetes.
  
  
  
  The study team conducted semistructured qualitative interviews with 20 patients with type 2 diabetes who were receiving care at safety-net clinics in Southern California. Transcripts were analyzed using grounded theory to identify emergent themes across participants.
  
  
  
  Participants described managing diabetes with limited financial resources as often a game of balance and negotiation, whereby purchasing healthy foods is abandoned because of a more pressing concern in their life. Although participants described strategic attempts at incorporating healthy dietary practices for diabetes management into their daily decisions, these efforts were significantly impeded by the existence of persistent and seemingly insurmountable barriers.
  
  
  
  Although the challenges that low-income patients face in managing their diabetes may seem insurmountable at times, there are several ways that health care providers can help reduce the burden of these challenges, including tailoring their recommendations to incorporate the everyday socioeconomic environment of patients and engaging in clear, open communication with patients.
authors.affiliation: University of Michigan, Ann Arbor, Michigan (Ms Rendle)|Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
authors.forename: Katharine A S
authors.initials: KA
authors.lastname: Rendle
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
authors.forename: Suepattra G
authors.initials: SG
authors.lastname: May
authors.affiliation: University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
authors.forename: Visith
authors.initials: V
authors.lastname: Uy
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
authors.forename: Caroline K
authors.initials: CK
authors.lastname: Tietbohl
authors.affiliation: University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)|University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D002140:California / Q000453:epidemiology; D003142:Communication; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011203:Poverty / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data