(DCP041) EXPLORING DIABETES STIGMA IN EMERGENCY HOUSING SHELTERS THROUGH FORUM THEATRE: A COMMUNITY-BASED PARTICIPATORY RESEARCH STUDY

Background: People with diabetes often face stigma from care providers, the media, or members of the public. Diabetes stigma can lead to self-blame and may cause individuals to conceal their condition, compromising self-care and predisposing them to complications. The experience of diabetes stigma may intersect with other stigmas, including towards those experiencing homelessness. Currently, little is known about the experience of diabetes stigma among people living in emergency housing shelters and possible interventions which might lessen the impact of these intersecting stigmas.

METHODS AND RESULTS: The Calgary Diabetes Advocacy Committee (CDAC) is a community-based participatory research group comprised of five co-researchers with lived experience of diabetes and homelessness and academic researchers that support them. The co-researchers utilized forum theatre to depict their experiences of stigma when residing in emergency housing shelters and to explore possible solutions. Forum theatre is a theatrical approach that encourages exploration of social issues to highlight acts of oppression, such as stigma, and encourages audience members (referred to as spect-actors) to suggest possible social interventions. Spect-actors included shelter staff, researchers, healthcare professionals, and members of the public. Stigmatizing experiences in emergency shelters identified through script development involved the public, shelter staff, other shelter clients, and healthcare workers and led to feelings of guilt, blame, and neglect. Those with type 1 and 2 diabetes had differing diabetes stigma experiences in emergency housing shelters. Those with type 2 diabetes often felt that others implied that their diabetes was a result of their health behaviour choices and that they were solely responsible. Individuals with type 1 diabetes voiced that their use of insulin was often conflated with illicit drug usage by the public, and as a result, they tried to conceal their insulin use. Beyond the public, shelter staff misinterpreted hypo- and hyper-glycemic events as substance use and intoxication, sometimes leading to forceful removal from shelters. Through the theatrical depiction of these events, possible interventions identified by nine spect-actors included questioning the lack of glucometers in shelters, offering alternative food to individuals with diabetes to better suit their dietary needs, and questioning the lack of insulin access in shelters.

Conclusion: People with diabetes experiencing homelessness face diabetes stigma that results in unique hardships and requires interventions that prioritize increasing awareness about diabetes and trauma-informed care within emergency shelters.