Cities Changing Diabetes: Vulnerability Assessment in Copenhagen

Research output: Book/ReportReportResearch

Ulla Christensen, Elisabeth Clare Kristensen, Gritt Marie Hviid Malling

The overall objectives of the Vulnerability Assessmentis to gain in-depth information on what attributes the most to vulnerability seen from the perspectives of vulnerable diabetes patients and citizens at risk. In Copenhagen, we focused on how everyday life influences the perceptions and experiences of health risks and illness among fifty vulnerable patients and citizens at risk in the city. We aimed at investigating how the local environment and practices influence individual practices and behavior, and how the management of diabetes is influenced by social factors.
Also, the analysis addressed how the vulnerable population perceived and experienced the availability of the healthcare services in their local community. In order to get sufficient knowledge about the most vulnerable patients we also conducted focus group discussions with seven healthcare professionals. The research questions were analyzed within the three domains defined in UCL’s Vulnerability Assessment Tool, i.e. the Formal domain, the Community domain andthe Vulnerability domain.
The Vulnerability domain: The analysis showed that there are several degrees of vulnerability. The healthcare professionals characterized their patients as vulnerable due to a complex combination of social and physical issues. Eventhough only some of the patients participating in this study could be described by this complex set of characteristics, they had all experienced a range of problems in their everyday life which affect the prioritization of diabetes or health issues in general. Vulnerability was closely associated with the Danish term “manglende overskud”, in English ‘lack of reserves of energy’. Due to a range of issues and worries in everyday life, such as comorbidity, unemployment, economic problems, major life events and loneliness, management of diabetes and healthy lifestyle practice could be ‘just too much’. Among the vulnerable patients diabetes was not on their mind because of pain and discomfort caused by other diseases. Some found that diabetes is not a severe condition compared to other diseases. As long as there were no symptoms, the patients in this study did not react to the disease. The importance of diabetes in everyday life as well as the management of it was influenced by social factors and life events. Compared to other chronic diseases, diabetes 2 did not represent a serious health risk among citizens at risk. Unemployment was a very important factor that attributed to the overall vulnerability of the informants and living alone and lacking social support further made it difficult to cope with small everyday tasks. Both informants and health professionals emphasized how important it is that lifestyle changes and self-care management are as tangible and easy aspossible.
The Formal domain: Patients received assistance from their GP, the out-patient clinic at the hospitals, the Diabetes Association and the Community Health Center (CHC). Compared to the patients, the citizens at risk did not have the same regular contact with the healthcare system. The majority of the citizens at risk had no knowledge of the prevention services and courses provided by the CHC. The GPs had a decisive role in the vulnerable patients’ and citizens’ access to healthcare services through information and referral. Information on healthy lifestyle was appreciated by the informants but they also stated that they did not need more lectures or knowledge. It was not lack of knowledge that made lifestyle changes difficult. The informants were worried that the limited time periods at the CHC were too short for them to keep on practicing a healthier lifestyle when finishing the courses. In addition, some informants found that the opening hours at the CHC and other health facilities did not match well with their work life. Travel distances to healthcare facilities also seemed to be a barrier for those who had physical limitations. Some patients with non-western background had difficulties applying for financial support for their diabetes medicine because they did not understand the applications forms. Some mentioned economic challenges when paying for their medicine, but most of the informants had not experienced major economic problems in relation to their diabetes.
The Community domain: Almost all informants enjoyed the green areas near their neighbourhood which gave them the possibilities to meet up and do social and physical activities together. Due to physical limitations only few liked to do more vigorous exercise. Gym facilities in the local area were sometimes used and it was important that they were free of charge. Many female informants with non-western background found that the social network initiatives provided them with a purpose in their everyday life, while especially men and some of the female informants of Danish origin did not find that social activities in their neighbourhood met their interests. Managing diabetes and keeping the prescribed diet was difficult when participating in social activities with friends and family. Some felt uncomfortable talking about their diabetes as they did not want to draw negative attention to themselves. Only few had the need to share their experiences with other diabetes patients. Some of them did not know where to find such opportunities, while several female patients with non-western background had this need met at the social network initiatives.
Original languageDanish
Place of PublicationKøbenhavn
PublisherKøbenhavns Universitet
Number of pages50
Publication statusPublished - 2016

ID: 165655665