Beliefs About Racism and Health Among African American Women With Diabetes: A Qualitative Study

Abstract

Exposure to racism has been linked to poor health outcomes. Little is known about the impact of racism on diabetes outcomes. This study explored African American (AA) women's beliefs about how racism interacts with their diabetes self-management and control. Four focus groups were conducted with a convenience sample of 28 adult AA women with type 2 diabetes who were recruited from a larger quantitative study on racism and diabetes. The focus group discussions were transcribed verbatim and analyzed by the authors. Women reported that exposure to racism was a common phenomenon, and their beliefs did in fact link racism to poor health. Specifically, women reported that exposure to racism caused physiological arousal including cardiovascular and metabolic perturbations. There was consensus that physiological arousal was generally detrimental to health. Women also described limited, and in some cases maladaptive, strategies to cope with racist events including eating unhealthy food choices and portions. There was consensus that the subjective nature of perceiving racism and accompanying social prohibitions often made it impossible to address racism directly. Many women described anger in such situations, and the tendency to internalize anger and other negative emotions, only to find that the negative emotions would be reactivated repeatedly with exposure to novel racial stressors, even long after the original racist event remitted. AA women in this study believed that racism affects their diabetes self-management and control. Health beliefs can exert powerful effects on health behaviors and may provide an opportunity for health promotion interventions in diabetes.

Self-Care Disparities Among Adults with Type 2 Diabetes in the USA

“…[32–37] Furthermore, racial/ethnic minorities with T2D disproportionately experience competing family responsibilities and priorities,[38] financial strain,[38; 39] and daily and chronic stressors. [40–42]…”

Differential Effect of Race, Education, Gender, and Language Discrimination on Glycemic Control in Adults with Type 2 Diabetes

“…15,16 Research has found a negative relationship between discrimination and an array of health outcomes. 17 Most studies have focused on racial or gender discrimination, but some studies have shown that discrimination based on language 18,19 and level of health literacy 19 can also lead to increased psychological stress in patients with diabetes.…”

Stressors May Compromise Medication Adherence Among Adults With Diabetes and Low Socioeconomic Status

“…Finally, the TAPS assesses stressors experienced in the past year, whereas the SDSCA assesses self-care adherence in the past week, and the ARMS-D assesses diabetes medication adherence in general. While differences in the assessed timeframe between measures may offer an alternative explanation for the findings, we have found that experiencing a single, chronic stressor (e.g., racism) at any point during the lifespan has harmful effects on diabetes self-care (Wagner et al, 2011). …”

“…Among adults with type 2 diabetes mellitus (T2DM), racial/ethnic minorities are more likely than their NHW counterparts to report experiencing financial strain (Jeon, Essue, Jan, Wells, & Whitworth, 2009), and studies have identified several stressors disproportionately affecting racial/ethnic minorities with T2DM, including financial strain (Jiang, Beals, Whitesell, Roubideaux, & Manson, 2008; Russell et al, 2010), family dysfunction (Elstad, Tusiofo, Rosen, & McGarvey, 2008; Jiang et al, 2008; Mendenhall et al, 2012; Russell et al, 2010), daily hassles (Spencer et al, 2006), and discrimination (Jiang et al, 2008; Wagner et al, 2011). …”