Exploring the role of psychological factors in diabetes management for people experiencing housing instability: a qualitative descriptive study of providers' perspectives across Canada

Psychological factors, such as mental health and cognition, are significant contributors to diabetes management, especially for those experiencing housing insecurity. Our aim was to explore the role of psychological factors in diabetes management for people experiencing housing instability from the perspective of providers. We designed a qualitative descriptive study that consisted of a secondary analysis of semi-structured interviews with a range of health and social care providers from programs that addressed the needs of people with diabetes who were also experiencing homelessness. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis. Ninety-six participants completed semi-structured interviews. We identified four themes that showed (i) experiences of stigma and trauma influence clients' relationships with providers and their diabetes care seeking behaviors, (ii) immediate psychological safety concerns are generally given priority over diabetes in the client's care, (iii) substance use can create challenges when trying to manage diabetes and lead to diabetic emergencies, and (iv) varying cognitive abilities and social supports compromise a client's ability to complete self-management tasks. We conclude that providers have a nuanced understanding of psychological factors and the challenges they create for clients with diabetes experiencing housing insecurity.