The patient was newly diagnosed with type 2 diabetes

Full Answer Section

         

• • Employment Status: Is the patient employed? What are their work hours and demands? Irregular work schedules or physically demanding jobs can make consistent meal times, medication adherence, and exercise difficult.
  • Debt/Financial Strain: High levels of debt can cause stress, which impacts blood sugar control, and may force patients to prioritize other expenses over their health.
• Education Access and Quality:
  • Literacy Level: Can the patient read and understand health information, medication labels, and instructions for blood glucose monitors? Low literacy can hinder understanding of complex diabetes management concepts.
  • Health Literacy: Does the patient understand basic health concepts and have the ability to make appropriate health decisions? This is different from general literacy and directly impacts self-management.
  • Access to Diabetes Education Programs: Are there affordable or free diabetes education classes available in their community, and does the patient have the means (transportation, time) to attend?
• Healthcare Access and Quality:
  • Insurance Status: Does the patient have health insurance? What is their coverage for medications, supplies, specialist visits (endocrinologist, dietitian, podiatrist, ophthalmologist), and diabetes education? High deductibles or co-pays can be barriers.
  • Access to Providers: Is there a shortage of healthcare providers (doctors, nurses, dietitians) in their area? Is there a long wait time for appointments?
  • Transportation: Does the patient have reliable transportation to get to appointments, pharmacies, and grocery stores?
  • Language Barriers: If the patient speaks a different language, are interpreters available? Are educational materials translated?
  • Cultural Competence of Providers: Do healthcare providers understand and respect the patient's cultural beliefs and practices regarding food, health, and illness?
• Neighborhood and Built Environment:
  • Food Environment ("Food Deserts"): Does the patient live in an area with limited access to affordable, healthy food options (fresh fruits, vegetables, whole grains)? Is their primary food source convenience stores or fast food?

Sample Answer

         

1. Social Determinants of Health (SDOH) to Assess for Diabetes Self-Management:

  SDOH are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. For a patient with newly diagnosed Type 2 Diabetes, the nurse should assess the following SDOH:

• Economic Stability:
  • Income Level/Poverty: Does the patient have sufficient income to afford healthy food, medications (even with insurance co-pays), diabetes supplies (test strips, lancets), and transportation to appointments? Low income can lead to food insecurity and inability to purchase necessary supplies.