Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1061 — Racial Disparities in Glucose Control: A Qualitative Evaluation of Potential Mechanisms

Shacter HE (CHERP) , Shea JA (CHERP), Akhabue E (University of Pennsylvania), Sablani N (Macalester College), Long JA (CHERP)

African Americans (AA) have a higher prevalence of diabetes mellitus, more complications, and worse glucose control. Improved glucose control among AA has the potential to minimize complications and reduce disparities in diabetic outcomes. The objective of this study was to elucidate barriers to glucose control that may be unique to AA.

We conducted focus groups with veterans in four categories of glucose control: AA well controlled (AAWC); AA poorly controlled (AAPC); whites well controlled (WWC); and whites poorly controlled (WPC). Control was defined as having a glycosylated hemoglobin of < 8% on two occasions. Two focus groups were conducted for each population, using nominal group technique to define factors that “made it easy” and “made it hard” to control diabetes. Sessions were recorded and transcribed. Three researchers independently coded the transcripts using constant comparison methodology to define emergent themes. Discrepancies were resolved by consensus. NVivo7 software was used to analyze results.

Well controlled groups were similar in reporting self-care (23%), healthcare (17%), and psychosocial factors (16%) as important in controlling glucose. Although AAPC frequently cited self-care as important (19%), they also noted difficulty following self-care practices (17%), and psychosocial factors interfering with glucose control (16%). Specifically, AAPC noted: difficulty following a diabetic diet (20% of self-care codes); stress and depression interfering with glucose management (33% of psychosocial codes); and struggling with temptation (15% of psychosocial codes). These difficulties were similar to those faced by WPC. Uniquely, AAPC were less likely to report positive healthcare experiences (4% compared with 16-18% in other groups: chi-square p < 0.001), with negative codes relating to poor access (25%) and poor relationships with providers (14%).

AAPC understood the importance of self-care in glucose control, but were lacking skills to do so effectively. Interventions aimed at improving access to and communication with providers, handling stress, and avoiding temptation may give these patients the tools needed to better manage glucose and minimize disparities among veterans with diabetes.

Negative healthcare experiences were unique to AAPC, suggesting that experiences within the VA vary across populations and that this difference may relate to the ability of patients to control glucose.