Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Abstract

Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents’ perceptions of factors that influence the use of diabetes technology. Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne’s health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child’s choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.

The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review

“…In addition, Agarwal et al 79 found that providers often played the role of gatekeeper, with some participants (either non-Hispanic Black or Hispanic) only learning about the existence of these technologies once participating in the study. Other participants stated the same experiences as those found by Howe et al 73 The lower continuation rate could be due to issues with the support systems surrounding CGM use or due to changes in reimbursement eligibility. The presence of implicit bias was further investigated in a vignette study, in which the patients had different names, which demonstrated the presence of ethnic bias in 34% of the provider cohort.…”

“…As such, not only are ethnic minorities less likely to be initiated on CGMs but they are also less likely to continue it once attained. The lower prescription rate could be indicative of the use of subjective criteria and the presence of implicit biases in offering CGMs to ethnic minorities, which was also found by Howe et al 73 They found that the argument of needing to have stable blood glucose levels prior to initiation was often used in communication with non-Hispanic Black parents, whereas it was not with non-Hispanic White parents. In addition, Agarwal et al 79 found that providers often played the role of gatekeeper, with some participants (either non-Hispanic Black or Hispanic) only learning about the existence of these technologies once participating in the study.…”

“…It was found that non-Hispanic Black parents experienced that their children were treated differently for wearing CGM devices and being bullied for it. 73 In addition, non-Hispanic Black parents reported higher levels of shame regarding the diagnosis of diabetes and being judged for having a child with the disease. It would be said that the disease, T1D in this case, was the consequence of a faulty lifestyle, even if this belief is untrue.…”

Patient, family, community, and health care system predictors of continuous glucose monitor use.

“…Finally, although not specifically examined in this study, there are persistent and marked sociodemographic disparities in the use of CGM (Addala et al, 2021). Furthermore, qualitative data suggest that there are differences in patient and caregiver factors related to CGM among racially and ethnically minoritized youth with T1D (e.g., perceptions of diabetes technologies; Howe et al, 2023; Mencher et al, 2022). Future research and clinical efforts should therefore be mindful of issues of health equity, recruit racially and ethnically diverse samples, examine how social determinants of health relate to consistent CGM use, and develop and test interventions specifically for underrepresented groups.…”

Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?

“…At present, underserved people with T1D are less likely to use technologies such as continuous glucose monitoring (CGM) and insulin pump therapy 44,45 . There are numerous contributors to the digital divide in T1D, 46–54 as illustrated in Figure 3.…”