Individual-, Community-, and Health System–Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development

Campbell, Jennifer A.; Egede, Leonard E.

doi:10.1177/0145721719889338

Cited by 24 publications

(24 citation statements)

References 67 publications

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“…It is essential to promote access to DSMES services by identifying and addressing population barriers and health inequities (3). Barriers may include socioeconomics, cultural factors, misaligned schedules, health insurance shortfalls, perceived lack of need, or limited encouragement from healthcare professionals to engage in DSMES (28, 44,45). SDOH related to the target population should guide service design and delivery (46).…”

Section: Standard 2: Population and Service Assessmentmentioning

confidence: 99%

2022 National Standards for Diabetes Self-Management Education and Support

et al. 2022

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By the most recent estimates, 34.2 million people in the U.S. have diabetes (1). At the same time, 88 million people are at increased risk for developing type 2 diabetes. The U.S. also sees an increasing prevalence of both type 1 and type 2 diabetes in children and adolescents (2). Thus, more than 122 million Americans are at risk for developing devastating complications associated with chronic hyperglycemia (1). Diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes (PWD). "The purpose of DSMES is to give PWD the knowledge, skills, and confidence to accept responsibility for their self-management. This includes collaborating with their healthcare team, making informed decisions, solving problems, developing personal goals and action plans, and coping with emotions and life stresses" (3). DSMES interventions include activities that support PWD to implement and sustain the self-management behaviors and strategies to improve diabetes and related cardiometabolic conditions and quality of life on an ongoing basis. Despite progress in diabetes treatment modalities, glycemic and cardiometabolic outcomes continue to decline in the U.S. (4). Now, more than ever, the provision of DSMES is a vital component of the full treatment for diabetes.PWD are at risk for distress, life stress, and clinical depression, which can lead to poor health outcomes (5). The National Standards for Diabetes Self-Management Education and Support (hereinafter referred to as the National Standards) encourage the DSMES team to acknowledge and address the emotional burden of living with and managing diabetes-diabetes distress-and to consider the multitude of daily demands and decisions required of PWD, their families, and caregivers (6-9). To further illustrate, PWD generally visit their primary care physician (PCP)/other qualified healthcare professional two to four times per year, where the average appointment lasts 15-20 min and addresses four or more health conditions (10). This equates to the person with diabetes (PWD) spending less than 1% of their life with their healthcare professionals (10). Therefore, diabetes management decisions largely fall on PWD and/or caregivers, further highlighting the importance of increasing access to DSMES services that support ongoing self-management and decision making.The National Standards define timely, evidence-based, quality DSMES services that meet or exceed the Centers for Medicare & Medicaid Services quality standards. While the acronym DSMES is used in the literature and in current practice, it is important to note that the term diabetes self-management training (DSMT) is exclusively used when describing the Medicare benefit for diabetes self-management. The Medicare benefit for DSMT was established by the Balanced Budget Act (BBA) of 1997 with a final rule (65 FR 83130) published on 29 December 2000, implementing the BBA provisions and DSMT regulations (Title 42 of the Code of Federal Regulation sections 410.140 to 410.146). The DSMT benefit...

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Section: Standard 2: Population and Service Assessmentmentioning

confidence: 99%

2022 National Standards for Diabetes Self-Management Education and Support

et al. 2022

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“…Specific for inner-city African Americans, an integrative review exploring the barriers across the individual, community, and health system levels found that across 46 studies, 2 focused on quality of life as an outcome for diabetes. 21 The current findings suggest that quality of life should be considered more frequently as a patient-reported outcome and that factors at the individual, community, and health system levels should be incorporated into interventions to improve quality of life among inner-city African Americans with diabetes.…”

Section: Implications For Diabetes Care and Education Specialistsmentioning

confidence: 86%

“…Drawn from a social ecological model, this recently published framework was developed based on integration of 2 behavioral frameworks for diabetes and informed by the literature on diabetes outcomes for inner-city African Americans. 21 This conceptual framework was used to select measured variables for inclusion in this study that represent barriers for inner-city African Americans with type 2 diabetes across the individual, community, and health systems levels. All measures selected have been previously validated and cited according to published validation.…”

Section: Methodsmentioning

confidence: 99%

“…17,19 The aim of this study is to examine the association of individual, community, and health system factors on quality of life for inner-city African Americans with type 2 diabetes. Specifically, this study uses a newly developed conceptual framework 21 for quantifying contextual factors across levels of influence that impact quality of life for inner-city African Americans with type 2 diabetes. This study hypothesized that independent correlates of quality of life would occur at the individual, community, and health system levels among inner-city African Americans after adjusting for relevant covariates.…”

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confidence: 99%

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Quantifying the Influence of Individual, Community, and Health System Factors on Quality of Life Among Inner-City African Americans With Type 2 Diabetes

Campbell

Yan

Walker

et al. 2021

The Science of Diabetes Self-Management and Care

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Purpose The purpose of this study is to examine the association of individual, community, and health system factors on quality of life among inner-city African Americans with type 2 diabetes. Methods Primary data from a cross-sectional study with a community sample of 241 inner-city African Americans with type 2 diabetes were analyzed. Paper-based surveys were administered in which the SF-12 was used to capture the physical component (PCS) and mental component (MCS) of quality of life. Four regression approaches (sequential, stepwise with backward and forward selection, and all possible subsets regression) were used to examine the influence of individual, community, and health system factors on PCS and MCS after adjusting for relevant covariates using a conceptual framework. Results In fully adjusted models, having less than a high school education and having major depression were associated with lower quality-of-life scores for MCS across all 4 regression approaches. Being employed was positively associated with better quality-of-life scores for PCS across all 4 regression approaches. PCS was higher across all 4 regression approaches for those reporting a history of trauma. At the health systems level, usual source of care was associated with better PCS across 3 regression approaches. Conclusions These results highlight key factors that influence quality of life among inner-city African Americans with type 2 diabetes that could be targets for interventions in this population. However, additional research is needed to understand existing pathways that may be driving many of these relationships.

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“…Frameworks such as the chronic care model clearly indicate that health care does not occur in a vacuum and recent work has shown that individual, community and health systems factors are important drivers of diabetes outcomes. 46 Therefore, as diabetes care moves away from traditional models of care, outward facing interventions using public health approaches are greatly needed to address the role that neighborhood factors are playing on diabetes management and outcomes. For example, a number of public sector and community-based efforts have demonstrated that violence and crime can be reduced in communities by improving connectivity, 47,48 developing and expanding green space across communities and surrounding vacant lots, 47,48 and safe ride programs.…”

Section: Discussionmentioning

confidence: 99%

Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes

et al. 2021

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Purpose Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes. Design Cross-sectional study. Setting Two primary care clinics in southeastern US. Participants 615 adults aged 18 years and older. Measures Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record. Analysis Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control. Results In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = −.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = −.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c. Conclusion Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.

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Individual-, Community-, and Health System–Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development

Cited by 24 publications

References 67 publications

2022 National Standards for Diabetes Self-Management Education and Support

2022 National Standards for Diabetes Self-Management Education and Support

Quantifying the Influence of Individual, Community, and Health System Factors on Quality of Life Among Inner-City African Americans With Type 2 Diabetes

Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes

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