Understanding inequities in access to diabetes technologies in children and young people with type 1 diabetes: qualitative study of healthcare professionals’ perspectives and views

Aims: We explored healthcare professionals’ perceptions and understandings of the factors and considerations underlying inequities in technology access in CYP with type 1 diabetes.
Methods: We interviewed (n=29) healthcare professionals working in paediatric diabetes in England recruited from (n=15) purposively selected sites. We analysed data thematically.
Results: Interviewees highlighted multiple, often overlapping barriers to accessing technology that CYP with type 1 diabetes from deprived and/or ethnic minority backgrounds faced. They described the impacts of deprivation on technology uptake, together with the complex social, ethnic, and cultural factors that could also reinforce disparities in technology access. Interviewees further highlighted staffing shortfalls as a significant barrier to supporting CYP using technology, especially those from under-represented groups who they perceived as requiring more staffing time in order to be trained to use the technology. While interviewees suggested that unconscious bias has become less prominent, they reported being less likely to recommend technology (especially pumps) to CYP/caregivers who they feared would not use it safely and effectively (e.g., those with low literacy levels). Interviewees also described the technology commissioning process as an unequal and unfair ‘postcode lottery.’
Conclusions: Our findings suggest that without targeted interventions, technology inequities may continue to persist amongst children/young people (CYP) from the most and least deprived areas and from white and ethnic minority groups in the UK. Additionally, our findings suggest that closing the technology gap will require large-scale governmental and health policies aimed at fostering socioeconomic, ethnic, and cultural equality alongside targeted measures to improve technology accessibility.