Underrepresented Voices: Impacts of Social Determinants of Health on Type 1 Diabetes Family Management in Single-Parent, Black Families

Morone, Jennifer; Cronholm, Peter F.; Teitelman, Anne M.; Hawkes, Colin P.; Lipman, Terri H.

doi:10.1016/j.jcjd.2022.05.012

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…The health of children with diabetes experiencing the greatest disparities must be improved more rapidly than that of the rest of the population so that gaps can be narrowed. 21,36 Future studies should continue to extend and expand our understanding of racial disparities to inform interventions.…”

Section: Discussionmentioning

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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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: Discussionmentioning

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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“…Similar observations have been made in other qualitative studies. A qualitative study examining impacts of SDOH in single parents of Black children with T1D reported the economic burden of food cost a major barrier [26]. Cox et al [23] also reported in their T1D population that food insecurity had a disproportionate impact on families after T1D diagnosis compared with before diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Adverse Social Determinants of Health in Children with Newly Diagnosed Type 1 Diabetes: A Potential Role for Community Health Workers

Lai,

Craven,

Hershey

et al. 2024

Pediatric Diabetes

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Objective. There are significant socioeconomic and racial disparities in glycemic control among children with type 1 diabetes (T1D). Community health workers (CHWs) have been shown to improve outcomes in marginalized, high-risk populations. The purpose of this qualitative study was to describe the prevalence and the impact of adverse social determinants of health (SDOH) on diabetes care soon after a diagnosis of pediatric T1D, and investigate the potential supportive role of a CHW. Research Design and Methods. Caregivers of youth <17-year old, with new onset T1D, and government insurance at the time of diagnosis were enrolled. Baseline demographic and SDOH questionnaires were administered at the time of enrollment. Semistructured interviews were performed at 3 months after diagnosis to explore the effect of SDOH on diabetes care and the impact of a CHW. Results. Seventeen caregivers were enrolled, 10 were randomly assigned to a CHW. Two-thirds of caregivers identified at least one SDOH need at enrollment; 35% of caregivers identified two SDOH needs. Interviews revealed that the two major themes identified as barriers to diabetes care were caregivers’ employment and financial issues. Social support was identified as a facilitator. The transition from hospital to home after the diagnosis of T1D was improved for families working with a CHW, and the CHW was identified as a strong source of support. Conclusions. There is a high prevalence of adverse SDOH in families from lower socioeconomic status at the time of diagnosis of pediatric T1D. These SDOH have a significant impact on families’ abilities to care for their children. Preliminary data suggest that CHWs can be a facilitator to the diabetes care. This trial is registered with NCT04238949.

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“…Growing evidence substantiates that social determinants of health (SDOH)—including the conditions in which people are born, grow, work, live, and age—affect health, functioning, and health-related quality of life outcomes ( 35 , 36 ). Importantly, SDOH barriers exacerbate economic burden, or “financial toxicity,” which is one of the core issues underlying health inequities historically ( 37 , 38 ). Such economic impact of SDOH has been demonstrated among more common chronic conditions and some rare diseases ( 38–40 ), but the literature is still scarce in gMG.…”

Section: Introductionmentioning

confidence: 99%

The economic burden of individuals living with generalized myasthenia gravis and facing social determinants of health challenges

Hughes,

Howard,

Silvestri

et al. 2023

Front. Public Health

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ObjectiveBetter understanding the impact of social determinants of health (SDOH) barriers from the patient perspective is crucial to improve holistic patient support in generalized myasthenia gravis (gMG), a rare autoimmune disorder with high disease and treatment burden. The objective of this study was to identify economic challenges experienced by individuals living with gMG and SDOH barriers to better address current unmet needs.MethodsAdults (18–75 years) living with gMG and experiencing SDOH barriers in the United States were recruited to a mixed-methods study including qualitative interviews and a web-based quantitative survey. Quotas were implemented to include a balanced spread of baseline demographic categories including insurance type, living environment, and employment status among the study sample. Direct and indirect economic challenges were identified by degree of concern.ResultsThe survey was completed by 38 individuals living with gMG, the majority of whom were enrolled in public insurance and not employed. The most commonly reported major economic concerns were managing funds for emergency care (66%), loss of income (61%), and non-medical expenses (58%), highlighting the diversity of economic challenges. Individuals who were using public insurance plans, living in non-urban environments, and unemployed experienced pronounced challenges around managing non-medical costs and accessing government assistance.ConclusionBoth direct and indirect costs were emphasized as major concerns among individuals living with gMG and SDOH barriers. Increasing access to relevant, personalized, and holistic resources, including care management, should be prioritized to improve disease management and outcomes for individuals living with gMG.

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Underrepresented Voices: Impacts of Social Determinants of Health on Type 1 Diabetes Family Management in Single-Parent, Black Families

Cited by 3 publications

References 37 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

Adverse Social Determinants of Health in Children with Newly Diagnosed Type 1 Diabetes: A Potential Role for Community Health Workers

The economic burden of individuals living with generalized myasthenia gravis and facing social determinants of health challenges

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