Diabetes is the seventh leading cause of death in the United States (U.S.). Within the U.S. diabetes prevalence is highest in the Southeast. Recent estimates indicate 21 million Americans have been diagnosed with diabetes and an additional 8.1 million live with undiagnosed diabetes. While diabetes self-management education (DSME) is an evidence-based strategy that has been shown to improve diabetes outcomes and health status, best practice DSME services are not uniformly accessible. Disparities in access to healthcare services in general and DSME in particular are major public health priorities. Disparities in access to services contribute to existing disparities in diabetes outcomes including mortality. Variation in access to services have been found to be strongly associated with variables such as race, social-economic status, and place of residence, and have been linked to health disparities. Studies have demonstrated that geographical access to health services is reduced by increasing travel distance, travel time, travel cost, and effort to travel, and leads to decreased utilization of services. To date no studies have been done to specifically research access to DSME and social determinants of health (SDOH) using a geographical information system (GIS). Understanding spatial relationships of geographical, environmental, SDOH, access, and health outcomes related to diabetes could provide important insight into where and how to provide DSME services.
New researchers are needed to explore existing health disparities and the association to healthcare service access. To address this need both educational and research opportunities must be provided. As faculty at a state university, our primary roles are teaching, scholarship and service. One effort of these combined roles is to teach and motivate students to engage in meaningful research.
PURPOSE: The goals of this research project was two-fold: 1.) to identify geographical accessibility to DSME among persons in Alabama; and 2.) to expose undergraduate (UG) students to research and strengthen the research environment at the university by providing mentored research opportunities. GIS technology was used to empirically and visually identify and examine spatial relationships between variables related to diabetes and access to DSME services. The Specific Aims of this study were to: Aim 1. Determine the percentages of the Alabama population with geographical access to DSME services at 30 and 60-minutes of travel time by age, sex, race, rural status, and socioeconomic status. Aim 2. Train and develop a research team focused on addressing diabetes health disparities and access to DSME services using GIS. This presentation will describe a research study conducted entitled “Using Geographical Information Systems to Examine Access to Diabetes Self-Management Education Services in a Rural State.” It will describe the development and training of the UG research team focused on addressing diabetes health disparities, student research mentoring, and the scope of student research involvement. The study results have been previously presented.
Methods:
To this end, we implemented a research study to allow UG students to be immersed in mechanisms of both technical and intellectual aspects of basic health service access research. This research-based immersion project utilized current faculty research to provide opportunity for UG student interactive participation and used grant funds to increase student research participation through student compensation and incentives. The specific immersion goal was to provide UG students with: 1) the foundation of scientific knowledge related to research including ethics, scientific integrity, research design, implementation, and dissemination of research; 2) opportunities to network and collaborate with funded researchers; 3) career choices related to doctoral or academic positions; 4) knowledge on preparing a competitive grant proposals. Students were expected to:
- Learn to use ArcGIS software
- Attend regular meetings related to the research project
- Participate in literature review
- Participate in data collection and management
- Participate in data analysis and interpretation
- Develop and present research findings (poster or oral paper presentations) at regional and national professional conferences
- Participate in manuscript development.
Results:
We successfully recruited five UG students who had goals to pursue a career in academia and research. Students were immersed in research experiences in the areas of diabetes, health disparities, geographical access and geographic information systems as a part of a research team. The selected students were from majors associated with the research study (such as nursing, geography, medicine, public health, etc.). UG students with no prior background in this field were able to learn to use ArcGIS software to solve geographic problems. Students learned how to collect and edit data as needed, carry out a range of analyses, and communicate results in written and map format. UG students were included in all phases of the research process from literature review to professional presentations and manuscript development. This project significantly enhanced opportunities for research and training for UG students, built research capacity, and accelerated our research program.
Conclusion:
The study has broad public health significance as it addresses priority areas of diabetes, DSME, and access to services aimed to reduce adverse diabetes outcomes and disparities. The study was used as the foundation for student involvement in bankable GIS skills, data analysis, presentations, manuscript development, and future student-developed research to study other healthcare access disparities and other health outcomes.