Social Determinants of Health and Health Care Delivery: African American Women’s T2DM Self-Management

Abstract

African American (AA) women have high prevalence of Type 2 diabetes mellitus (T2DM) and complications. No studies have been conducted about how social determinants of health and health care delivery affect their T2DM self-management. The purpose was to describe how social determinants of health and healthcare delivery may influence AA women’s T2DM self-management using qualitative descriptive methodology ( N = 10). Ten participants were interviewed. Participants’ geographical location, education, level of income, health literacy, and systemic racism, that is, healthcare delivery services, for example, inadequate healthcare services, providers’ assumptions about the patient’s knowledge of diabetes, providers’ attitudes toward patients, and stigma related to diabetes as a disease were identified. Understanding the role of social determinants of health and the health care delivery system in influencing T2DM self-management is a powerful tool for providers and practitioners for improving practice and health care policies to decrease health disparities and improve health outcomes among AA women with T2DM.

Racism in healthcare: a scoping review

“…Articles that do not have racism as their main focus and look at specific healthcare contexts or indicators examine the following: trust in healthcare in the USA [ 114 ], trust in physicians in the USA [ 115 ], experiences of chronic illness in Australia [ 116 ], burn injury in pediatric care in Australia [ 117 ], pediatric acute care in Canada [ 118 ], acute care in Australia [ 119 ], end of life care in the USA [ 120 ], mental healthcare [ 121 ] in the USA [ 122 ], reproductive, maternal and perinatal care in the USA [ 123 – 128 ], in Australia [ 129 ] and Canada [ 130 ], cancer care in the USA [ 131 – 133 ] and the UK [ 134 ], dental care in the USA [ 135 ], diabetes care in the USA [ 7 , 136 ], sexual healthcare in the USA [ 137 ], and finally perceptions of patient centered care in the USA [ 138 ]. The majority of these articles are qualitative except for 5 articles [ 7 , 114 , 115 , 129 , 133 , 139 ] as well as one mixed method article [ 121 ].…”

“…Studies focusing on specific racialized minorities examine mostly experiences of African Americans/Blacks in USA ( n = 28) [ 7 , 32 , 33 , 38 , 39 , 43 , 45 , 53 , 55 , 65 , 67 , 69 , 71 , 72 , 75 , 77 , 78 , 81 – 83 , 93 , 115 , 120 , 122 , 127 , 131 , 140 , 141 ]. Other studies in the USA look at Hispanics ( n = 10), [ 47 , 52 , 54 , 107 , 108 , 121 , 135 – 138 ], American Indians [ 48 , 85 , 106 ], as well as other ethnicities such as Asian Americans [ 54 , 114 ].…”

“…In healthcare, as in other institutions, racism continues to persist and constitutes a major barrier towards achieving equitable and responsive healthcare. This is documented by research showing differential and unequal processes of delivering, accessing, and receiving healthcare across various countries and healthcare indicators [ 2 , 6 ] including diabetes care [ 7 ], mental healthcare [ 8 ], maternal healthcare [ 9 ], preventive vaccination [ 10 ], end-of-life care [ 11 ], cardiology care [ 12 ] and pain management [ 13 ]. Research has also documented that racialized minorities not only receive inadequate quality healthcare but are also viewed as less desirable healthcare users compared to majority groups [ 14 ].…”

“I put diabetes on the shelf”: African-American Women’s Perceptions of Risk for Diabetes Complications

“…About 50% of all AA women will develop diabetes and face the risk of dying from diabetes related complications compared to other racial/ethnic groups in the US (Sumlin, 2017). AA women face health disparities due to limited access to health care, risk for diseases, genetics, cultural practices, health behaviors, lack of research among this population, and risk perceptions, among other factors (National Institute of Allergy and Infectious Diseases, 2013; Ochieng & Crist, 2020). AA women are disproportionately diagnosed with T2DM and its associated complications (Migliore et al 2015).…”

“…(National Institute of Allergy and Infectious Diseases, 2013; Ochieng & Crist, 2020). AA women are disproportionately diagnosed with T2DM and its associated complications (Migliore et al 2015).…”