“throwing Drops Of Water At A Wildfire”: Patient And Provider Strategies For Navigating Housing Instability And Type 2 Diabetes

Marlene Edelstein

This thesis is restricted to Yale network users only. It will be made publicly available on 08/28/2021


Type 2 diabetes and housing access are growing independent and intersecting crises in the United States, and unstable housing is associated with poor health outcomes for people with type 2 diabetes. A growing body of evidence points to the challenges of adhering to diabetes management without access to stable housing, and that provider behavior is impacted when their patients face housing instability. In this qualitative study, we investigate the ways that primary care providers and people with type 2 diabetes strategically navigate the challenges posed by homelessness and unstable housing. Semi-structured interviews from two qualitative studies were analyzed. The first set of interviews was conducted with 40 residents of New Haven, Connecticut who qualified for, or resided in, subsidized housing. The second set of interviews was conducted with 18 primary care clinicians practicing in Connecticut. Coding analysis for both sets of interviews was conducted independently before they were analyzed together. We found that providers addressed the challenges of managing type 2 diabetes in the context of unstable housing by individualizing care, reducing the risk of acute complications, and by going above and beyond for patients. Patients addressed these challenges by building strategic alliances and by creating structure. Our results suggest that individual solutions involve tradeoffs, are tenuous, and are insufficient at addressing these poor health outcomes. Systemic interventions are warranted.