BACKGROUND Type 1 diabetes is a complex chronic condition which requires lifelong treatment with insulin. Health outcomes are dependent on ability to self-manage the condition. Socioeconomic inequalities have been demonstrated in access to treatment and health outcomes for adults with type 1 diabetes; however, there is a paucity of research exploring how these disparities occur. This study explores the influence of socioeconomic factors in gaining access to intensive insulin regimens for adults with type 1 diabetes. METHODS We undertook a qualitative descriptive study informed by a phenomenological perspective. In-depth face-to-face interviews were conducted with 28 patients and 6 healthcare professionals involved in their care. The interviews were analysed using a thematic approach. The Candidacy theory for access to healthcare for vulnerable groups framed the analysis. RESULTS Access to intensive insulin regimens was through hospital-based specialist services in this sample. Patients from lower socioeconomic groups had difficulty accessing hospital-based services if they were in low paid work and because they lacked the ability to navigate the healthcare system. Once these patients were in the specialist system, access to intensive insulin regimens was limited by non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication. These factors could also affect access to structured diabetes education which itself improved access to intensive insulin regimens. Contact with diabetes specialist nurses and attendance at structured diabetes education courses could ameliorate these barriers. CONCLUSIONS Access to intensive insulin regimens was hindered for people in lower socioeconomic groups by a complex mix of factors relating to the permeability of specialist services, ability to navigate the healthcare system and patient interactions with healthcare providers. Improving access to diabetes specialist nurses and structured diabetes education for vulnerable patients could lessen socioeconomic disparities in both access to services and health outcomes.

中文翻译：

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成人1型糖尿病患者接受强化胰岛素治疗的社会经济差异：对患者和医疗保健专业人员观点的定性研究。

背景技术1型糖尿病是复杂的慢性病，​​需要终身用胰岛素治疗。健康结果取决于自我控制疾病的能力。在患有1型糖尿病的成年人获得治疗和健康结局方面已经证明了社会经济不平等；但是，很少有研究探索这些差异是如何发生的。这项研究探讨了社会经济因素对成人1型糖尿病患者接受强化胰岛素治疗的影响。方法我们采用现象学的观点进行了定性描述性研究。对28位患者和6位参与护理的医护人员进行了深入的面对面访谈。使用主题方法对访谈进行了分析。弱势群体获得医疗保健的候选资格理论构成了该分析的框架。结果本样本中通过医院的专科服务获得了强化胰岛素治疗方案。社会经济地位较低的患者如果从事低薪工作，并且由于他们缺乏导航医疗保健系统的能力，则难以获得基于医院的服务。这些患者进入专科系统后，由于不符合医疗保健专业目标，健康素养差，社会心理问题和沟通质量低下，限制了接受强化胰岛素治疗的机会。这些因素也可能会影响进行结构性糖尿病教育的机会，而糖尿病本身会改善接受强化胰岛素治疗的机会。与糖尿病专科护士接触并参加结构化糖尿病教育课程可以缓解这些障碍。结论社会经济地位较低的人群难以接受强化胰岛素治疗，这是由于以下因素的综合综合影响：专科服务的可渗透性，导航医疗保健系统的能力以及患者与医疗保健提供者的互动。改善对糖尿病患者的专业护士的访问和对糖尿病患者的结构化糖尿病教育，可以减少获得服务和健康成果方面的社会经济差距。导航医疗保健系统以及与医疗保健提供者进行患者互动的能力。改善对糖尿病患者的专业护士的访问和对糖尿病患者的结构化糖尿病教育，可以减少获得服务和健康成果方面的社会经济差距。导航医疗保健系统以及与医疗保健提供者进行患者互动的能力。改善对糖尿病患者的专业护士的访问和对糖尿病患者的结构化糖尿病教育，可以减少获得服务和健康成果方面的社会经济差距。