Endocrine Abstracts

Background: Poverty and deprivation are associated with poorer diabetes health outcomes and lower uptake of diabetes technology in paediatric populations. This qualitative service evaluation explores staff perspectives on current variation in provision of diabetes technology prescribed to children and young people from high deprivation areas. Challenges and ideas for reducing variation are discussed.

Methods: Semi-structured interviews were conducted with 16 multidisciplinary professionals from a Paediatric Diabetes service about their experiences of diabetes technology provision. Interviews were analysed using thematic analysis with a critical realist approach.

Results: Four main themes were found: 1) Communication and Dialogue with families who are less proactive in seeking diabetes technology, or are unfamiliar with healthcare systems, and difficulties with interpreters were identified as barriers to prescribing technology. Flexible approaches like home visits and adaptable job roles helped facilitate prescription. 2) Service Capacity - Perceived overwhelm on the service and the need for more staff resources for families from deprived areas hindered technology provision. Having a dedicated health inequalities team helped bridge gaps. 3) Staff Beliefs about Technology – While some viewed technology as risky and overwhelming in certain contexts, others believed it would improve quality of life when appropriately matched. Beliefs about technology were also found to influence when tech was discussed with families felt to be managing well on other regimens. 4) Understanding and Addressing Barriers – Social barriers such as lack of parental supervision, work inflexibility and limited access to technology were seen as safety risks. Some staff struggled to connect with families due to cultural, societal or class divides, and identified open communication and self-reflection on biases as crucial.

Conclusions: Several areas were felt to contribute to the variation in the prescribing and uptake of diabetes technology, including communication gaps, staffing constraints, perceptions about technology risks/benefits, and difficulties understanding families’ circumstances. Initiatives like dedicated health inequalities teams, cultural awareness training, co-production with families, varied resources, and diversifying staff roles may enhance access. Understanding and overcoming unconscious biases through open dialogue is key to services improving equity. Future research should explore the acceptability and feasibility of staff recommendations to address health inequalities in paediatric diabetes care.