Food Insecurity and Low Self-efficacy are Associated with Health Care Access Barriers Among Puerto-Ricans with Type 2 Diabetes

Racial/ethnic minorities are disproportionately affected by barriers to health care access and utilization. The primary objective
was to test for an independent association between household food insecurity and health care access/utilization. In this cross-sectional
survey, 211 Latinos (predominantly, Puerto-Ricans) with type 2 diabetes (T2D) were interviewed at their homes. Factor analyses
identified four barriers for health care access/utilization: enabling factor, doctor access, medication access and forgetfulness.
Multivariate logistic regression models examined the association between each of the barrier factors and food insecurity controlling
for sociodemographic, cultural, psychosocial, and diabetes self-care variables. Higher food insecurity score was a risk factor
for experiencing enabling factor (OR = 1.46; 95% CI = 1.17–1.82), medication access (OR = 1.26; 95 CI% = 1.06–1.50), and forgetfulness
(OR = 1.22; 95 CI% = 1.04–1.43) barriers. Higher diabetes management self-efficacy was protective against all four barriers.
Other variables associated with one or more barriers were health insurance, perceived health, depression, blood glucose, age
and education. Findings suggest that addressing barriers such as food insecurity, low self-efficacy, lack of health insurance,
and depression could potentially result in better health care access and utilization among low income Puerto-Ricans with T2D.