Background Annually, in the UK, up to 24,000 people with diabetes die prematurely from preventable complications. Individuals in low socioeconomic status (SES) and minority groups are disproportionately affected by diabetes with higher prevalence, provision of lower quality care and worse outcomes. The reasons for this are not completely understood and are likely to be context specific. In the North East of England over 44% of those with a diagnosis of Type 2 diabetes (T2D) live in the most deprived areas, with these individuals seeing worse outcomes than the national average. The objective of this study was to understand the main barriers and facilitators to T2D self-management in individuals with low SES in the North East of England.

Methods Data were generated through semi-structured interviews (audiotaped and transcribed verbatim) with 11 individuals with low SES and T2D and 12 professionals who support them. Recruitment was through community based purposive and snowball sampling with low SES defined by self-reported income, education, occupation, and established area level deprivation indices (indices of multiple deprivation). Analysis was inductive, in line with a constructivist grounded theory approach, and was conducted simultaneously to data generation. Familiarisation and initial coding were followed by memoing, ongoing theoretical sampling and constant comparison to inform focused, and finally theoretical coding once thematic saturation was achieved. NVivo software was employed to support data management.

Results Of participants with T2DM 8 were female, 3 were male and the mean age was 55 years. All individuals had at least two indicators of low SES. Of recruited professionals 3 operated in the third sector, 6 in primary care and 3 across both primary and secondary care. Three central concepts were derived from the data: (1) Beliefs about the importance of managing diabetes, (2) Importance of building competence, (3) Ability to prioritise self-care. Each of these concept’s linked to an identified core variable: Empowerment. A conceptual framework is proposed which identifies individual, provider, community and health care system barriers and facilitators to empowering individuals to manage T2DM alongside low SES.

Results To address inequalities in T2DM we must first understand why they exist. Findings identified empowerment as a key mechanism to support individuals living with T2DM and low SES to better self-manage their condition. This study may have implications for future intervention development and implementation.