Implementing an evidence-based practice in an urban community is a difficult task. Patient complexity, resource limitations, service access, training constraints, and patient avoidance of care are all issues in the urban community. Local factors such as geography can have an impact on program implementation and operations. To reduce potential barriers to program participation, the program design should account for long travel times, transportation availability or lack thereof, and site availability (CDC.gov, 2021). Diabetes self-care management programs will be an excellent addition to the urban community of African American men with diabetes. To overcome these obstacles, local health organizations and health insurance companies should be approached for funding in exchange for transportation to programs and program incentives for participants, such as assistance in applying for food vouchers. Given the environment, these barriers are regarded as unavoidable.

The two external barriers that may arise during implementation are non- adherence, and financial constraints. Patient barriers influence non-adherence to the recommended diabetes self-management regimen. These impediments make disease management more difficult. Only a few studies have looked at patients’ perceived barriers to general diabetes self-management on a broad scale. An international study identified diabetes-related distress as a major factor contributing to patients’ poor adherence to self-management. According to local studies, difficulty in making lifestyle changes and an insufficient health care system communication interface were linked to poor diabetes self-management. (Adu, 2019). Moreover, financial constraints have meant that patients have not been able to access clinical diabetes supplies and eat according to adequate food recommendations. Other studies examined obstacles to the auto-management of certain specific diabetes areas. The absence of knowledge of a specific diet plan in patients and the perceived belief that healthy behavior is socially unacceptable have hindered healthy eating and exercise. In addition, depressive signs and personal belief in medication have been observed to be linked to less diabetes adherence.

The two internal barriers are referrals and treatment and limited clinical professionals in the area between 50% and 80% of people with diabetes have limited knowledge about the disease and limited skills in diabetes management. (Boakye, 2018). When it comes to program site recruitment, we know that the program will be taught at local clinics, but the goal is to make sure that the program is specifically tailored to African American men. Increasing the connections between community resources and clinical services is one way to improve diabetes management. Diabetes self-management education and support (DSMES) programs link diabetics to effective clinical services in their communities. DSMES is typically provided to patients at the time of diagnosis, during annual assessments, and when transitions or new disease complications occur that impact self-management, and it is guided by evidence-based standards. According to one study, DSME programs that are culturally tailored to African American men can help to close the gender gap. To overcome such obstacles, it is critical to find clinicians who are familiar with the urban population and can relate to participants. This can be accomplished by interviewing prospective clinicians about their previous experiences with the population. (Prucell, 2015)

References

Adjei Boakye, E., Varble, A., Rojek, R., Peavler, O., Trainer, A. K., Osazuwa-Peters, N., & Hinyard, L. (2018). Sociodemographic Factors Associated With Engagement in Diabetes Self-management Education Among People With Diabetes in the United States. Public health reports (Washington, D.C. : 1974), 133(6), 685–691. https://doi.org/10.1177/0033354918794935

Adu, M. D., Malabu, U. H., Malau-Aduli, A., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS one, 14(6), e0217771. https://doi.org/10.1371/journal.pone.0217771

Center for Disease Control (February 4, 2021) Overcoming Barriers to Referral and Treatment Retrieved from https://www.cdc.gov/diabetes/dsmes-toolkit/referrals-participation/overcoming-barriers.html

Peña-Purcell NC, Jiang L, Ory MG, Hollingsworth R. Translating an evidence-based diabetes education approach into rural african-american communities: the “wisdom, power, control” program. Diabetes Spectr. 2015 May;28(2):106-15. doi: 10.2337/diaspect.28.2.106. PMID: 25987809;