Socioeconomic status (SES) challenges are common barriers to type 2 diabetes (T2D) management. We sought to obtain patient perspectives on T2D interventions sensitive to SES barriers. We conducted focus groups (n=8) with a socioeconomically diverse sample of adults with T2D (n=53). Focus groups used a semi-structured moderator guide and were recorded and transcribed verbatim. We utilized the constant-comparison method for qualitative content analysis. Findings revealed three primary themes: 1) gaps in food and nutrition resources, 2) challenges to healthful eating, and 3) potential interventions to address barriers noted in Themes 1 and 2. Supporting categories for Theme 1 included: lack of structured food resource management education (e.g., healthy eating on a limited budget), need for peer-based or health coaching support specific to low SES circumstances (e.g., facing trade-offs between buying food and paying for medications), and mixed experiences with nutrition counseling (e.g., lack of sensitivity to challenges of healthy eating, behavior change). Supporting categories for Theme 2 included challenges related to stress, mental health, comorbidities, and insufficient food insecurity interventions. To help overcome these barriers, participants described three broad categories of preferred intervention strategies. First, they endorsed SES-informed lifestyle intervention (e.g., focusing on food resource management, sensitive health coaching and nutritional counseling). Second, they expressed enthusiasm for group-based learning opportunities, such as cooking classes and support groups conducted among peers with similar SES. Third, they suggested provision of additional resources such as meal delivery programs, healthy food subsidies, and assistance in accessing food aid. These interventional strategies can be tested and refined to help improve health for disadvantaged individuals with T2D.


S.A. Stotz: None. K.A.B. Ricks: None. S.A. Eisenstat: None. D.J. Wexler: Other Relationship; Self; Novo Nordisk A/S. S.A. Berkowitz: None.


DK109200, DK092923

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at