Skip to main content

Advertisement

SpringerLink
Log in

Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objective

Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system.

Research Design and Methods

We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis.

Results

Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans.

Conclusion

To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Engelgau MM, Narayan KM, Herman WH. Screening for type 2 diabetes. Diabetes Care. 2000;23:1563–80.

    Article  CAS  PubMed  Google Scholar 

  2. Prevention CfDCa. National Diabetes Statistics Report 2020. In Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2020

  3. Dankner R, Geulayov G, Olmer L, Kaplan G. Undetected type 2 diabetes in older adults. Age Ageing. 2009;38:56–62.

    Article  PubMed  Google Scholar 

  4. Marteau TM, Kim LG, Upton J, Thompson SG, Scott AP. Poorer self-assessed health in a prospective study of men with screen-detected abdominal aortic aneurysm: a predictor or a consequence of screening outcome? J Epidemiol Community Health. 2004;58:1042–6.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Saaristo T, Peltonen M, Lindstrom J, Saarikoski L, Sundvall J, Eriksson JG, Tuomilehto J. Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome. Diab Vasc Dis Res. 2005;2:67–72.

    Article  PubMed  Google Scholar 

  6. Diabetes C, Complications Trial Research G, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  7. Force USPST, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Owens DK, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for prediabetes and Type 2 diabetes: US preventive services task force recommendation statement. JAMA. 2021;326:736–43.

    Article  Google Scholar 

  8. Caspersen CJ, Thomas GD, Boseman LA, Beckles GL, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health. 2012;102:1482–97.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Aronson D. Cross-linking of glycated collagen in the pathogenesis of arterial and myocardial stiffening of aging and diabetes. J Hypertens. 2003;21:3–12.

    Article  CAS  PubMed  Google Scholar 

  10. Nguyen QM, Xu JH, Chen W, Srinivasan SR, Berenson GS. Correlates of age onset of type 2 diabetes among relatively young black and white adults in a community: the Bogalusa Heart Study. Diabetes Care. 2012;35:1341–6.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Lee DC, Young T, Koziatek CA, Shim CJ, Osorio M, Vinson AJ, Ravenell JE, Wall SP. Age disparities among patients with type 2 diabetes and associated rates of hospital use and diabetic complications. Prev Chronic Dis. 2019;16:E101.

    Article  PubMed Central  PubMed  Google Scholar 

  12. QuickStats: age-adjusted percentages* of adults aged >/=18 years without a usual place of health care,(dagger) by region ( section sign) - National Health Interview Survey, 2017( paragraph sign). MMWR Morb Mortal Wkly Rep 2019;68:319

  13. QuickStats: percentage* of adults aged 18–64 years with a usual place for medical care,(dagger) by race/ethnicity (section sign) - National Health Interview Survey, 2010 and 2015( paragraph sign). MMWR Morb Mortal Wkly Rep 2016;65:722

  14. LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44:2093–105.

    Article  PubMed Central  PubMed  Google Scholar 

  15. White RO, Chakkalakal RJ, Presley CA, Bian AH, Schildcrout JS, Wallston KA, Barto S, Kripalani S, Rothman R. Perceptions of provider communication among vulnerable patients with diabetes: influences of medical mistrust and health literacy. J Health Commun. 2016;21:127–34.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Victor RG, Ravenell JE, Freeman A, Leonard D, Bhat DG, Shafiq M, Knowles P, Storm JS, Adhikari E, Bibbins-Domingo K, Coxson PG, Pletcher MJ, Hannan P, Haley RW. Effectiveness of a barber-based intervention for improving hypertension control in Black men the BARBER-1 study: a cluster randomized trial. Arch Intern Med. 2011;171:342–50.

    Article  PubMed  Google Scholar 

  17. Hess PL, Reingold JS, Jones J, Fellman A, Knowles P, Ravenell JE, Kim S, Raju J, Ruger E, Clark S, Okoro C, Ogunji O, Knowles P, Leonard D, Wilson RP, Haley RW, Ferdinand KC, Freeman A, Victor RG. Barbershops as hypertension detection, referral, and follow-up centers for black men. Hypertension. 2007;49:1040–6.

    Article  CAS  PubMed  Google Scholar 

  18. Osorio M, Ravenell JE, Sevick MA, Ararso Y, Young T, Wall SP, Lee DC. Community-based hemoglobin A1C testing in barbershops to identify Black men with undiagnosed diabetes. JAMA Intern Med. 2020;180:596–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. American DA. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81-90.

    Article  Google Scholar 

  20. American DA. Standards of medical care in diabetes–2010. Diabetes Care. 2010;33(Suppl 1):S11-61.

    Article  Google Scholar 

  21. Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013;57(8):1152–1173.

  22. Benkert R, Cuevas A, Thompson HS, Dove-Meadows E, Knuckles D. Ubiquitous Yet unclear: a systematic review of medical mistrust. Behav Med. 2019;45:86–101.

    Article  PubMed  Google Scholar 

  23. Ravenell JE, Johnson WE Jr, Whitaker EE. African-American men’s perceptions of health: a focus group study. J Natl Med Assoc. 2006;98:544–50.

    PubMed Central  PubMed  Google Scholar 

  24. Walker RJ, Smalls BL, Bonilha HS, Campbell JA, Egede LE. Behavioral interventions to improve glycemic control in African Americans with type 2 diabetes: a systematic review. Ethn Dis. 2013;23:401–8.

    PubMed  Google Scholar 

  25. Gary TL, Genkinger JM, Guallar E, Peyrot M, Brancati FL. Meta-analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Educ. 2003;29:488–501.

    Article  PubMed  Google Scholar 

  26. Whittemore R. Behavioral interventions for diabetes self-management. Nurs Clin North Am. 2006;41:641–54 (viii).

    Article  PubMed  Google Scholar 

  27. Delahanty LM, Meigs JB, Hayden D, Williamson DA, Nathan DM. Diabetes prevenion program research G. psychological and behavioral correlates of baseline BMI in the diabetes prevention program (DPP). Diabetes Care. 2002;25:1992–8.

    Article  PubMed  Google Scholar 

  28. Koenigsberg MR, Bartlett D, Cramer JS. Facilitating treatment adherence with lifestyle changes in diabetes. Am Fam Physician. 2004;69:309–16.

    PubMed  Google Scholar 

  29. Ravenell JE, Whitaker EE, Johnson WE Jr. According to him: barriers to healthcare among African-American men. J Natl Med Assoc. 2008;100:1153–60.

    PubMed  Google Scholar 

  30. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504–10.

    Article  PubMed Central  PubMed  Google Scholar 

  31. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18:19.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Holroyd J. Implicit bias, awareness and imperfect cognitions. Conscious Cogn. 2015;33:511–23.

    Article  PubMed  Google Scholar 

  33. Blendon RJ, Buhr T, Cassidy EF, Perez DJ, Sussman T, Benson JM, Herrmann MJ. Disparities in physician care: experiences and perceptions of a multi-ethnic America. Health Aff (Millwood). 2008;27:507–17.

    Article  PubMed  Google Scholar 

  34. Alexander CM, Landsman PB, Teutsch SM. Diabetes mellitus, impaired fasting glucose, atherosclerotic risk factors, and prevalence of coronary heart disease. Am J Cardiol. 2000;86:897–902.

    Article  CAS  PubMed  Google Scholar 

  35. Tai ES, Lim SC, Tan BY, Chew SK, Heng D, Tan CE. Screening for diabetes mellitus—a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications. Diabetes Med. 2000;17:771–5.

    Article  CAS  Google Scholar 

  36. Samuels TA, Cohen D, Brancati FL, Coresh J, Kao WH. Delayed diagnosis of incident type 2 diabetes mellitus in the ARIC study. Am J Manag Care. 2006;12:717–24.

    PubMed  Google Scholar 

  37. Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care. 1993;16:642–52.

    Article  CAS  PubMed  Google Scholar 

  38. Ferdinand KC, Nasser SA. Racial/ethnic disparities in prevalence and care of patients with type 2 diabetes mellitus. Curr Med Res Opin. 2015;31:913–23.

    Article  PubMed  Google Scholar 

  39. Arnett MJ, Thorpe RJ Jr, Gaskin DJ, Bowie JV, LaVeist TA. Race, medical mistrust, and segregation in primary care as usual source of care: findings from the exploring health disparities in integrated communities study. J Urban Health. 2016;93:456–67.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Funding

This study was funded by grant K23DK110316 from the National Institute of Diabetes and Digestive and Kidney Disease.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA

    Melissa Rony, Carolina Quintero-Arias, Marcela Osorio, Yonathan Ararso, Stephen P. Wall & David C. Lee

  2. Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, 10003, USA

    Elizabeth M. Norman

  3. Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA

    Joseph E. Ravenell, Stephen P. Wall & David C. Lee

Authors
  1. Melissa Rony
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolina Quintero-Arias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcela Osorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yonathan Ararso
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elizabeth M. Norman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph E. Ravenell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephen P. Wall
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David C. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

D.C.L, M.R., and C.Q. researched data, contributed to discussion, and wrote, reviewed, and edited the manuscript. M.O. and Y.A. researched data and reviewed and edited the manuscript. S.P.W. contributed to the discussion and reviewed and edited the manuscript. E.M.N. and J.E.R. reviewed and edited the manuscript. All authors approved the final version of the manuscript. D.C.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to David C. Lee.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1

See Table 2.

Table 2 Interview questions
Full size table

Appendix 2

See Table 3.

Table 3 Patient characteristics
Full size table

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rony, M., Quintero-Arias, C., Osorio, M. et al. Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes. J. Racial and Ethnic Health Disparities 10, 3150–3158 (2023). https://doi.org/10.1007/s40615-022-01488-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-022-01488-z

Keywords

Search

Navigation