(CSEMP058) GROUP VERSUS INDIVIDUAL DIABETES EDUCATION FOR PERSONS WITH LIVED EXPERIENCE OF HOMELESSNESS IN CANADA

Abstract: Purpose
The purpose of this study was to explore various forms of diabetes self-management education (DSME), including group and individual sessions, for persons with lived experiences of homelessness (PWLEH) in Canada. DSME is essential for improved outcomes for those living with diabetes. PWLEH and diabetes have many barriers to diabetes management including access to appropriate DSME.
Methods
We conducted a qualitative descriptive study using open-ended interviews with healthcare and homeless sector service providers with experience in diabetes and/or serving those experiencing homelessness in five cities across Canada. We used NVivo qualitative data analysis software to facilitate thematic analysis, focusing on variations in DSME for persons with lived experience of homelessness.
Results
DSME was provided through mainstream diabetes groups, groups focused on PWLEH, and individual sessions. We found four themes, the first being a harm reduction approach during education tailored to PWLEH. Whether this was in a group or individual session, the harm reduction approach took into account patients' access to food, medications and supplies, as well as other comorbidities including mental health and substance use disorders. The second theme was assumptions in diabetes education, where the curriculum in group education may not meet the needs of an individual patient, especially in mainstream group education. The third theme was community building, where group education created supportive relationships among its members and benefited from peer-to-peer education. The final theme was the importance of trust and confidentiality in DSME, which was most easily met during individual education.
Conclusion
PWLEH experience unique challenges in managing diabetes. Diabetes education which is adapted to these individuals’ unique needs may be more successful and could be delivered both in individual and group settings.