Food Insecurity and Low Self-Efficacy Are Associated With Health Care Access Barriers Among Puerto-Ricans With Type 2 Diabetes

J Immigr Minor Health. 2012 Aug;14(4):552-62. doi: 10.1007/s10903-011-9551-9.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Blood Glucose / analysis
  • Connecticut
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / ethnology*
  • Female
  • Food Supply / economics*
  • Health Services / economics
  • Health Services / statistics & numerical data*
  • Health Services Accessibility / economics
  • Healthcare Disparities / economics
  • Healthcare Disparities / ethnology*
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Insurance, Health / economics
  • Insurance, Health / statistics & numerical data
  • Interviews as Topic
  • Male
  • Middle Aged
  • Puerto Rico / ethnology
  • Randomized Controlled Trials as Topic
  • Self Efficacy
  • Social Support
  • Socioeconomic Factors


  • Blood Glucose