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Dickinson JK, Posesorski RE, Djiovanis SG, Brady VJ. Impact of Negative or Stigmatizing Messages on Diabetes Outcomes: An Integrative Review. Sci Diabetes Self Manag Care 2024; 50:167-178. [PMID: 38454649 DOI: 10.1177/26350106241232644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose was to determine if negative or stigmatizing language and messaging have an impact on diabetes distress, outcomes, or care behaviors in people with diabetes. Since 2012, when the first language position statement was published, the way health care professionals talk to people with diabetes has been an ongoing topic of discussion. However, there have been no recent literature reviews evaluating the impact of problem language on outcomes among people with type 1 and type 2 diabetes. METHODS An integrative review was conducted using 4 electronic databases: CINAHL, Embase, Web of Science, and Medline (Ovid). Studies reporting on diabetes, language, stigma, diabetes distress, glycemic outcomes, and self-care behaviors were included. RESULTS The review included 9 studies, all of which were of high quality. The impact of negative or stigmatizing language on self-care behaviors was the most commonly addressed outcome. Whereas some studies revealed no change, others reported a decrease in self-care behaviors by people with diabetes who had negative perceptions of provider messages. Actual or perceived use of negative or stigmatizing language is linked to higher A1C. Four studies reported an association between messages and diabetes distress. CONCLUSIONS Negative/stigmatizing language has both an immediate and long-term effect on people with diabetes. The inconsistent approaches to studying language in diabetes makes it challenging to compare outcomes and identify themes. Future research is needed to identify effective interventions to change the messages in diabetes.
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Agurs-Collins T, Alvidrez J, ElShourbagy Ferreira S, Evans M, Gibbs K, Kowtha B, Pratt C, Reedy J, Shams-White M, Brown AG. Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity. Adv Nutr 2024; 15:100194. [PMID: 38616067 PMCID: PMC11031378 DOI: 10.1016/j.advnut.2024.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.
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Affiliation(s)
- Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States.
| | | | - Sanae ElShourbagy Ferreira
- National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States
| | | | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Marissa Shams-White
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Alison Gm Brown
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
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Kruser JM, Ashana DC, Courtright KR, Kross EK, Neville TH, Rubin E, Schenker Y, Sullivan DR, Thornton JD, Viglianti EM, Costa DK, Creutzfeldt CJ, Detsky ME, Engel HJ, Grover N, Hope AA, Katz JN, Kohn R, Miller AG, Nabozny MJ, Nelson JE, Shanawani H, Stevens JP, Turnbull AE, Weiss CH, Wirpsa MJ, Cox CE. Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2024; 21:187-199. [PMID: 38063572 PMCID: PMC10848901 DOI: 10.1513/annalsats.202310-925st] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the time-limited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient's response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial's duration. The plan's 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.
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Anim SB, Spurlark R, Turkson-Ocran RA, Bohr N, Soco C, Simonovich SD. A Systematic Review of the Relationship Between Discrimination, Racism, and Type 2 Diabetes Healthcare Outcomes for Black Americans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01751-x. [PMID: 37580438 DOI: 10.1007/s40615-023-01751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Disparities in type 2 diabetes (T2DM) risk, care, and complications impact Black Americans more than that of their White counterparts. This study aims to examine the association between discrimination, racism, and T2DM care and outcomes in Black Americans. METHOD The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS A total of six original research articles met the inclusion criteria, comprising three quantitative and three qualitative studies. Overall, the systematic review findings revealed that among Black Americans, perceived interpersonal discrimination and racism by healthcare professionals are associated with patients' behaviors that impact T2DM outcomes. The findings also revealed that provider-level factors such as communication, provider assumptions and attitudes, information sharing, shared decision-making, and disease management behaviors might influence T2DM outcomes in this population. DISCUSSION Better T2DM-related outcomes depend on optimal disease control through adequate disease management. Building a therapeutic and culturally appropriate relationship free of discrimination and racism is vital for optimal disease management and decreasing health disparities in this patient population. CONCLUSION Perceived interpersonal racism and discrimination by healthcare providers, among other sociocultural factors, play a crucial role in influencing some patient behaviors that affect T2DM health outcomes in this population. Efforts to decrease health disparities in this specific community should also focus on interventions addressing provider-level factors and behaviors perceived as racist or discriminatory.
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Affiliation(s)
- Sandra B Anim
- DePaul University School of Nursing, Chicago, IL, USA
| | | | | | | | - Cheryl Soco
- DePaul University School of Nursing, Chicago, IL, USA
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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Brown KK, Kindratt TB, Brannon GE, Sankuratri BYV, Boateng GO. Patient Experience with Their Health Care Provider Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus by Race and Ethnicity in the United States. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:20-30. [PMID: 36727093 PMCID: PMC9883667 DOI: 10.1089/whr.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
Objectives The study objective was to investigate differences in patient experiences with health care providers among non-pregnant women of childbearing age with diabetes mellitus (DM) by race/ethnicity. Design This study used cross-sectional data from the 2012-2018 Medical Expenditure Panel Survey. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 763; weighted n = 903,670). The key independent variable was race/ethnicity. The variables of interest included patient experiences with health care in the past 12 months: patient-provider communication (PPC); patient-provider racial/ethnic concordance; patient-provider gender concordance; and satisfaction. Results After adjusting for age, marital status, education, poverty level, health insurance, and perceived health status, non-Hispanic (NH) Black women had lower odds (adjusted odds ratio [aOR] = 0.04; 95% confidence interval [CI] = 0.01-0.11) of receiving care from a health care provider of the same race compared with NH white women. Similar results were found among Hispanic and NH women of other or multiple races. Hispanic women had lower odds (aOR = 0.18; 95% CI = 0.06-0.50) of seeing a health care provider of the same race/ethnicity compared with NH white women in adjusted models. There were no statistically significant differences in PPC, patient-provider gender concordance, and satisfaction with their health care provider among Hispanic, NH Black, or NH women of other or multiple races in comparison to NH White women. Conclusion There is a need to improve PPC quality and satisfaction in this patient population. Patient-provider racial/ethnic discordance among women of color with DM is concerning given the existing diabetes-related disparities. More research on women with DM is needed to inform and improve patient experience and health outcomes.
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Affiliation(s)
- Kyrah K. Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA.,Address correspondence to: Kyrah K. Brown, PhD, Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX 76019, USA,
| | - Tiffany B. Kindratt
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Grace Ellen Brannon
- Department of Communication, University of Texas at Arlington, Arlington, Texas, USA
| | | | - Godfred O. Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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Lin OM, Reid HW, Fabbro RL, Johnson KS, Batch BC, Olsen MK, Matsouaka RA, Sanders LL, Chung ST, Svetkey LP. Association of Provider Perspectives on Race and Racial Health Care Disparities with Patient Perceptions of Care and Health Outcomes. Health Equity 2021; 5:466-475. [PMID: 34316530 PMCID: PMC8309434 DOI: 10.1089/heq.2021.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Research suggests that providers contribute to racial disparities in health outcomes. Identifying modifiable provider perspectives that are associated with decreased racial disparities will help in the design of effective educational interventions for providers. Methods: This cross-sectional study investigated the association between primary care provider (PCP) perspectives on race and racial disparities with patient outcomes. Results: Study participants included 40 PCPs (70% White, 30% racial minority) caring for 55 patients (45% White, 55% Black) with type 2 diabetes mellitus. Associations of provider perspectives on race and racial disparities with patient variables (Interpersonal Processes of Care [IPC] Survey, which measures patient's ratings of their provider's interpersonal skills; medication adherence; glycemic control) were measured using Spearman correlation coefficients. Results suggest that Black patients of providers who reported greater skill in caring for Black patients had more positive perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of -0.43, 0.44, 0.46, all with p<0.05); however, Black patients of providers who believe that racial disparities are highly prevalent had more negative perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of 0.38, -0.53, -0.51, all with p<0.05). These same provider characteristics had no correlation with outcomes of medication adherence and hemoglobin A1c (HbA1c) or among White patients. Conclusion: Findings suggest that Black patients of providers who felt better equipped to take care of Black patients had a better experience. Therefore, educational interventions for providers may be most effective if they focus on skill development rather than increasing awareness about racial disparities alone.
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Affiliation(s)
- Olivia M Lin
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Hadley W Reid
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Kimberly S Johnson
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine Durham, North Carolina, USA.,Center for Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Bryan C Batch
- Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Roland A Matsouaka
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Linda L Sanders
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sangyun Tyler Chung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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