Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review
Bodil Rasmussen A B C D J , Karen Wynter
A B , Helen A. Rawson A E , Helen Skouteris F , Nicola Ivory G and Susan A. Brumby H I
+ Author Affiliations
- Author Affiliations
A Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
B Centre for Quality and Patient Safety Research – Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia.
C Department of Public Health, University of Copenhagen, Denmark.
D Faculty of Health Sciences, University of Southern Denmark, Denmark.
E Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia.
F Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia.
G Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
H School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia.
I National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia.
J Corresponding author. Email: bodil.rasmussen@deakin.edu.au
Australian Journal of Primary Health 27(4) 243-254 https://doi.org/10.1071/PY20110
Submitted: 6 May 2020 Accepted: 6 April 2021 Published: 7 July 2021
Journal Compilation © La Trobe University 2021 Open Access CC BY-NC-ND
Abstract
Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.
Keywords: chronic health conditions, comorbidities, diabetes, rural and remote communities, self-management.
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