September 07, 2023 Helping people who experience homelessness manage their diabetes

Who:

Dr. David Campbell, endocrinologist and associate professor of medicine, University of Calgary

Research highlights/discoveries:

• Working to reduce inequitable healthcare access for people experiencing homelessness, using a community-based participatory research approach that empowers study participants to contribute to potential solutions to the challenges they face

Dr. David Campbell at a glance:

• Selected for a Top 40 Under 40 Award by Avenue Calgary, a city lifestyle magazine (2022)

• Assistant professor, Departments of Medicine, Community Health Sciences & Cardiac Sciences, Cumming School of Medicine, University of Calgary (2019–2023)

• Completed post-doctoral fellowship, Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto (2018–2019)

• Completed clinical fellowship, Endocrinology & Metabolism, University of Calgary (2017–2019)

• Completed Doctor of Philosophy in Community Health Sciences, University of Calgary (2017)

• Completed Doctor of Medicine, University of Calgary (2012)

What challenges can someone who lives with diabetes and homelessness face?

Any disparity in health care and health outcomes—when income or living circumstances have a negative impact on people’s health—is something Dr. David Campbell is determined to expose, explore and help remedy, especially as it relates to diabetes. The endocrinologist and associate professor of medicine at the University of Calgary has helped to determine links between homelessness, poverty and diabetes outcomes [the long-term effects of living with the condition], and is also working to find ways to help improve health outcomes for this population.

Those who have diabetes and are experiencing homelessness face many challenges managing their disease, which results in more diabetes-related complications and poorer quality of life. Dr. Campbell’s research shows that, compared to those with diabetes who are housed, people who experience homelessness and live with diabetes have a five-fold increased risk of hospitalization for diabetes, an 85 per cent higher risk for heart attacks and strokes, and death rates that are 45 per cent higher.

Through a unique research approach and support from Diabetes Canada, Dr. Campbell is working to reduce the stigma faced by people experiencing social disadvantages and, in turn, is helping them to achieve better diabetes outcomes.

What is unique about the way you conduct your research?

With my team, I find participants who have lived the experience and are the real experts to guide our work and act as co-researchers. The way I think about research is that I exist to help do what the community wants to do and wants to know. For example, in my research project funded by Diabetes Canada, ‘Stories of Stigma: Experiences of Managing Diabetes While Homeless,’ we talked to people living with diabetes and homelessness to understand the challenges they have faced. It was a long list, but when we zeroed in, they said their top priority for research was the stigma and a lack of stigma awareness about what it’s like to live with diabetes in their circumstances.

When we interviewed people who work with this group—shelter staff, first responders, and more—to determine their level of awareness about diabetes, we found they didn’t really understand what these folks needed to thrive, but they wanted to have that knowledge. That led to the development of a narrative film, which we recently completed filming, that shares stories from patients who are experiencing homelessness with a goal of helping others understand them better. I’m very excited that we have been able to bring these stories to life, and I’m looking forward to seeing what changes we can make together. [The film, Low, will premiere at the Vascular 2023 conference running October 25-29 in Montreal; for now, it will be shown exclusively at conferences.]

What is your long-term goal in bringing these stories to light?

I hope to foster health providers’ empathy toward patients who struggle, rather than labelling them as “difficult” when they don’t do what we ask them to do.

When patients come into our offices, we don’t know what they are dealing with day to day, so it may be unreasonable to expect them to do the things we ask them to do while they are living in these circumstances. Plus, we’re so busy in our clinical environments that we often don’t have time to really engage one-on-one in relationships with patients. My hope is that my team and I can create interventions or tools that will help providers better understand and care for these patients so that their diabetes outcomes will be improved.

Longer term, I think we can learn from outreach teams in mental health and primary care. My next big project this fall will be to launch a mobile diabetes outreach service that will provide full-scale diabetes care in the communities, close to those who need it most. It will include diabetes education, specialist consultation, retinal and foot screening, and point-of-care blood glucose [sugar] testing. We can do all of that on the spot in a “one-stop-shop,” rather than sending people to see various specialists in hospitals and clinics that may be unfamiliar to them.

The last word

“By tackling health barriers for those experiencing homelessness, Dr. David Campbell is pioneering research through community collaboration. His approach fosters solutions at every step and reminds us that combining expertise with lived experiences creates a future where equity and health intertwine,” says Laura Syron, CEO and president of Diabetes Canada.

Did you know?

Nearly one in five Canadians experience food insecurity, or an inability to afford a sufficient quantity or quality of food. Food insecurity can increase the risk of type 2 and gestational diabetes, and can make it more difficult to manage all types of diabetes. Help us fund research like that of Dr. Campbell, which has the power to change lives. Donate now. #LetsEndDiabetes