Technology Utilization in Black Adolescents with Type 1 Diabetes: Exploring the Decision-Making Process

Mencher, Shana; Weinzimer, Stuart A.; Nally, Laura M.; Name, Michelle Van; Nuñez-Smith, Marcella; Sadler, Lois S.

doi:10.1089/dia.2021.0413

Cited by 17 publications

(17 citation statements)

References 38 publications

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“…In this study, we have shown that both patient beliefs and preferences and the diabetes teams’ attitudes toward decisions related to insulin pump use differed by race. Consistent with previous findings, 23 NHB parents in this study supported their child’s choice to not use diabetes devices that made their diabetes diagnosis visible, which could possibly exacerbate their child’s experience of diabetes-related stigma. Although CGM alarm features brought a feeling of safety, the NHB parents reported their children became self-conscious, confirming earlier reports that CGM alarms were perceived as embarrassing.…”

Section: Discussionsupporting

confidence: 90%

“…4,17 Recent phase 2 disparities research has focused on understanding the potential determinants of diabetes technology disparities. For example, Mencher et al, 23 in a qualitative study exploring factors that influenced decision making, reported that NHB adolescents and parents made decisions to not use diabetes technology because of worries of stigmatization and mistrust of the medical community. In another qualitative study, young adults with T1D reported that providers acted as gatekeepers for information about and prescription access for diabetes technology, that there was little shared decision making, and that their concerns about diabetes technology were not addressed.…”

mentioning

confidence: 99%

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Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Howe

Morone

Hawkes

et al. 2023

The Science of Diabetes Self-Management and Care

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Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents’ perceptions of factors that influence the use of diabetes technology. Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne’s health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child’s choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Howe

Morone

Hawkes

et al. 2023

The Science of Diabetes Self-Management and Care

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“…We know that people who are oppressed and marginalized by society are more vulnerable to psychological distress, such as anxiety, depression, which have both been associated with reduced use of these diabetes technologies [20]. It has also been described that there is a general lack of familiarity with T1D and consequently lack of exposure to diabetes technology in some communities [19 ▪▪ ]. While T1D summer camps can bridge these gaps for some children, studies show Black and Hispanic children are less likely to attend.…”

Section: Drivers Of Disparities In Diabetes Technology Usementioning

confidence: 99%

Addressing disparities in technology use among patients with type 1 diabetes: a review

Kanbour,

Everett

2023

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The benefits of continuous glucose monitors (CGMs) and insulin pumps in the management of type 1 diabetes are widely recognized. However, glaring disparities in access exist, particularly in groups that stand to benefit significantly from diabetes technology use. We will review recent data describing drivers of these disparities and approaches to address the disparities. Recent findings Several qualitative studies were published in recent years that have investigated the drivers of disparities reported over the past decades. These studies report that in addition to typical barriers seen in the diabetes technology, these patients have unique challenges that make insulin pumps and CGMs less accessible. Summary Barriers to technology use in these groups include stigmatization, lack of support, and financial constraints, provider biases, stringent insurance policies and clinic infrastructure. To address these inequities, multifaceted strategies across community, healthcare, and provider sectors are essential. Key initiatives include enhancing public awareness, refining health policies, ensuring access to high-quality care, and emphasizing patient-centered approaches. The equitable use of technology can further narrow the gap in T1D outcomes. The social and economic implications of suboptimal T1D management further underscore the urgency of these efforts for both improved health outcomes and cost-efficient care.

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“…Compared with White counterparts, frequency of blood glucose monitoring, insulin administration, and monitoring for ketoacidosis was lower among African American and Hispanic emerging adults compared with their White counterparts 12 . Feeling different from peers and not having peers with T1D was identified as a major barrier 13 …”

mentioning

confidence: 95%

“…12 Feeling different from peers and not having peers with T1D was identified as a major barrier. 13 Psychological factors such as diabetes distress contributes to selfmanagement behaviors. Diabetes distress is conceptually distinct from depression and refers to the emotional response to managing a complex chronic condition such as T1D.…”

mentioning

confidence: 99%

Racial-Ethnic Disparities in Technology Use and Healthcare in Persons With Type 1 Diabetes

Martyn‐Nemeth

Hayman

2022

J Cardiovasc Nurs

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Technology Utilization in Black Adolescents with Type 1 Diabetes: Exploring the Decision-Making Process

Cited by 17 publications

References 38 publications

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Addressing disparities in technology use among patients with type 1 diabetes: a review

Racial-Ethnic Disparities in Technology Use and Healthcare in Persons With Type 1 Diabetes

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