A qualitative evaluation of racial disparities in glucose control.
OBJECTIVE
Type 2 diabetes is more prevalent and severe among African Americans than among Whites. To elucidate barriers to glucose control that are unique to African Americans with poor glucose control we conducted a qualitative study among veterans with diabetes in an academic Veterans Affairs medical center.


METHODS
We enrolled African American and White veterans with diabetes; participants' glucose control was described as well controlled or poorly controlled, and groups were organized on the basis of ethnicity and glucose control. Discussions were conducted by using modified nominal group technique to define factors that aided or hindered glucose control.


RESULTS
Well-controlled groups similarly reported that self-care, health care, and psychosocial factors were important in controlling glucose. Although poorly controlled African Americans cited self-care as important, they also noted difficulty following self-care practices and the interference of psychosocial factors with glucose control. Poorly controlled Whites were similar. Uniquely, poorly controlled African Americans were less likely to report positive healthcare experiences; their barriers were related to poor access and poor relationships with providers.


CONCLUSIONS
Poorly controlled African Americans endorsed healthy self-care behaviors but found it difficult to follow through. Interventions targeting the management of stress, depression, mood, and temptation, as well as improved access to and communication with providers may help these patients better manage their glucose and minimize disparities in diabetes outcomes. (Ethn Dis. 2009; 19:121-127)
Shacter
Hannah E
HE
University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
Shea
Judy A
JA
Akhabue
Ehimare
E
Sablani
Naveen
N
Long
Judith A
JA
D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D005260:Female; D017144:Focus Groups; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D012648:Self Care; D012944:Social Support; D012959:Socioeconomic Factors; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human