title: Clinicians' views of an intervention to reduce racial disparities in diabetes outcomes.
abstract: BACKGROUND
  Interventions that improve clinicians' awareness of racial disparities and improve their communication skills are considered promising strategies for reducing disparities in health care. We report clinicians' views of an intervention involving cultural competency training and race-stratified performance reports designed to reduce racial disparities in diabetes outcomes.
  
  
  METHODS
  Semistructured interviews were conducted with 12 physicians and 5 nurse practitioners who recently participated in a randomized intervention to reduce racial disparities in diabetes outcomes. Clinicians were asked open-ended questions about their attitudes towards the intervention, the causes of disparities, and potential solutions to them.
  
  
  RESULTS
  Thematic analysis of the interviews showed that most clinicians acknowledged the presence of racial disparities in diabetes control among their patients. They described a complex set of causes, including socioeconomic factors, but perceived only some causes to be within their power to change, such as switching patients to less-expensive generic drugs. The performance reports and training were generally well received but some clinicians did not feel empowered to act on the information. All clinicians identified additional services that would help them address disparities; for example, culturally tailored nutrition advice. Some clinicians challenged the premise of the intervention, focusing instead on socioeconomic factors as the primary cause of disparities rather than on patients' race.
  
  
  CONCLUSIONS
  The cultural competency training and performance reports were well received by many but not all of the clinicians. Clinicians reported the intervention alone had not empowered them to address the complex, root causes of racial disparities in diabetes outcomes.
authors.affiliation: Nuffield Trust, London, England. ruth.thorlby@nuffieldtrust.org.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Thorlby
authors.forename: Selena
authors.initials: S
authors.lastname: Jorgensen
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D054521:Cultural Competency; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012959:Socioeconomic Factors