Diabetes and pre-diabetes have reached crisis levels in Texas, particularly in rural areas with limited access to care. Diabetes is the seventh leading cause of death in the United States (U.S.) and is a major contributor to other chronic conditions, such as vision loss, vascular disease, kidney disease, heart disease, and other diseases, that can lead to premature death and reduced life expectancy.[1,2,3] Pre-diabetes is a precursor of type 2 diabetes as some people who experience pre-diabetes will be diagnosed with type 2 diabetes type.
Over the past decade, Texas has been leading the way with an increase of over 40% of persons living with this condition.[4,5] Previous research has shown different factors associated with these conditions, such as level of education, income, race and ethnicity as well as readiness to change behaviors.[6,7,8,9,10,11]. This Black Paper captures the lived experiences of rural Texans navigating diabetes to identify barriers and opportunities for equitable care. Partners described systemic barriers to affordable care, personal challenges in sustaining healthy behaviors, and the need for culturally responsive education. These findings guide policy, program, and provider recommendations that center rural Texans’ voices in building equitable health systems.
Building on prior research, this study deepened understanding by co-creating focus group questions with community partners whose lived experiences informed the process. It acknowledges participants perceived role in addressing the complexities of diabetes management, and it demands change through social policy and healthcare provider accountability. Evaluators utilized equitable power sharing approach centered on “community partners,” who are the participants in this study. We refer to the participants as “partners” meaning they were co-designers of the study by providing expertise through their voices. Collective meaning from partner voices is emphasized and researcher power and privilege are acknowledged through reflexivity by the dismantling of assumptions based on prevailing systemic narratives, such as: diabetes management is a matter of personal choice or lifestyle failure; rural communities need experts help to fix their
problems; and systems and their expertise reign over people living with diabetes as their own experts.
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