Table 3.

Types and Attributes of Neighborhood Resources Related to Chronic Disease Management Identified in Patient and Community Leader Interviews and Tours

Resource CategoryAttribute/Specific Examples
FOODPrice, quality, and availability of food for purchase
(grocery stores, restaurants, food pantries, food assistance programs, farmer's markets, free meals programs)Patient 3 identified a social service agency that provides food tailored to diabetes-related dietary restrictions.
Patient 7 explained that a grocery store is often messy and its prices can be twice the price of stores in other neighborhoods.
Free groceries and meals
Patient 1 noted that a church hands out free produce once a week.
PUBLIC SPACE/RECREATIONAL PLACESPlaces where people congregate
(community gardens, public parks, libraries, pools, playgrounds, community and senior centers)Patient 4 explained that there are activities for seniors in a park and a nearby area recently had a free health fair.
Patient 3 mentioned avoiding certain streets due to gun violence.
Accessibility of public spaces
Patient 2 identified a church as being handicap accessible.
HEALTHTypes and availability of local health services and programs
(healthcare facilities, community health centers, pharmacies)Patient 1 explained how much she loved her diabetes education class.
Patient 3 noted that it takes her a long time to get to her primary care clinic by bus.
Specific services that can be requested at local clinics and pharmacies
Patient 2 discussed how his pharmacy delivers medications with clear instructions.
SOCIAL SERVICESAvailability and accessibility of social services
(legal representation, mental health services, cultural resources, nutrition programs, access to government identification, homelessness programs)Community leader 10 pointed out a family resource center.
Free services available for vulnerable populations
Community leader 5 explained that a social services agency hosts free computer classes, a needle exchange and gives out free phones.
Patient 6 described a social services agency where he can get free socks helpful for his diabetes-related foot problems.
EDUCATIONAvailability of child-focused programs
(schools, afterschool programs, libraries, city colleges, education initiatives)Community leader 10 described an organization that provides culturally relevant services to low-income youth.
Learning opportunities for adults
Patient 6 described going to the public library to learn about health and meet people.
TRANSPORTATIONService quality, accessibility, and reliability of bus lines
(public transportation, paratransit, bus/taxi voucher programs)Patient 2 appreciated the reach of the public tram line but also explained that paratransit has long wait times and no same-day requests.
Community leader 6 explained that the public tram line does not consistently stop in their neighborhood.
HOUSINGHousing displacement
(affordable housing communities, assisted living facilities, shelters, single residency occupancy hotels)Patient 5 noted many buildings whose Black former owners were pushed out due to redevelopment policies and gentrification.
Housing tailored to specific populations
Community leader 8 noted a low-income housing community serving residents with special needs.
ARTAvailability of art and cultural events
(cultural shows, murals, musical events, museums)Patient 3 explained that a social services agency gives free tickets to the opera, ballet, and sports games.
Appreciation of public art
Patient 6 noted how much he liked a mural in his neighborhood.