Skip to main content

Advertisement

SpringerLink
Log in

Barriers and Facilitators to Shared Decision-making Among African-Americans with Diabetes

  • Brief Report
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

INTRODUCTION

Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans.

OBJECTIVE

We explored the barriers and facilitators to SDM among African-Americans with diabetes.

METHODS

Qualitative research design with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted using an iterative process. Participants: We utilized a purposeful sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center.

RESULTS

Patients identified multiple SDM barriers/facilitators, including the patient/provider power imbalance that was perceived to be exacerbated by race. Patient-related factors included health literacy, fear/denial, family experiences and self-efficacy. Reported physician-related barriers/facilitators include patient education, validating patient experiences, medical knowledge, accessibility and availability, and interpersonal skills.

DISCUSSION

Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

REFERENCES

  1. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651–61.

    Article  CAS  PubMed  Google Scholar 

  2. Larson EB, Fihn SD, Kirk LM, et al. The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine. J Gen Intern Med. 2004;19(1):69–77.

    Article  PubMed  Google Scholar 

  3. Richardson WC, Berwick DM, Bisgard JD, et al. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: Institute of Medicine; 2001.

    Google Scholar 

  4. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.

    CAS  PubMed  Google Scholar 

  5. Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.

    Article  CAS  PubMed  Google Scholar 

  6. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.

    Article  CAS  PubMed  Google Scholar 

  7. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of physician communication during medical visits. Am J Public Health. 2004;94:2084–90.

    Article  PubMed  Google Scholar 

  8. U.S. Commission on Civil Rights. Available at: http://www.usccr.gov/. Accessed on June 4, 2009.

  9. Richter DL, Kenzig MJ, Greaney ML, McKeown RE, Saunders RP, Corwin SJ. Physician-patient interaction and hysterectomy decision making: the ENDOW study. Ethnicity, needs, and decisions of women. Am J Health Behav. 2002;26(6):431–41.

    PubMed  Google Scholar 

  10. Sanchez MA, Bowen DJ, Hart A Jr, Spigner C. Factors influencing prostate cancer screening decisions among African American men. Ethn Dis. 2007;17(2):374–80.

    PubMed  Google Scholar 

  11. Peek ME, Quinn MT, Gorawara-Bhat R, Odoms-Young A, Wilson SC, Chin MH. How is shared decision-making defined among African-Americans with diabetes? Patient Educ Couns. 2008;72(3):450–58.

    Article  PubMed  Google Scholar 

  12. Glaser BG, Strauss AL. The discovery of grounded theory. Chicago: Aldine; 1967.

    Google Scholar 

  13. Charles C, Gafini A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med. 1997;44:681–92.

    Article  CAS  PubMed  Google Scholar 

  14. Ajzen I. The theory of planned behavior. Org Behav Human Decis Process. 1991;50:179–211.

    Article  Google Scholar 

  15. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15:351–77.

    CAS  PubMed  Google Scholar 

  16. Morgan DL. Focus groups as qualitative research. 2nd ed. Thousand Oaks, CA: Sage; 1997.

    Google Scholar 

  17. Jacobs EA, Rolle I, Ferrans CE, Whitaker EE, Warnecke RB. Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med. 2006;21(6):642–47.

    Article  PubMed  Google Scholar 

  18. Ong LML, de Haes JCJM, Hoos AM, Lammes FB. Doctor-patient communication: A review of the literature. Soc Sci and Med. 1995;40(7):903–8.

    Article  CAS  Google Scholar 

  19. Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20:175–84.

    Article  PubMed  Google Scholar 

  20. Coffman MJ. Effects of tangible social support and depression on diabetes self-efficacy. J Gerontological Nursing. 2008;34(4):32–9.

    Article  Google Scholar 

Download references

ACKNOWLEDGEMENTS

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Research and Training Center (P60 DK20595). Dr. Peek is supported by the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development program and the Mentored Patient-Oriented Career Development Award of the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK075006). Support for Dr. Chin is provided by a Midcareer Investigator Award in Patient-Oriented Research from the NIDDK (K24 DK071933-01).

The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript for publication. Dr. Peek had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland, MC 2007, Chicago, IL, 60637, USA

    Monica E. Peek MD, MPH, Shannon C. Wilson MPH, Michael T. Quinn PhD & Marshall H. Chin MD, MPH

  2. Diabetes Research and Training Center, University of Chicago, Chicago, IL, USA

    Monica E. Peek MD, MPH, Shannon C. Wilson MPH, Rita Gorawara-Bhat PhD, Angela Odoms-Young PhD, Michael T. Quinn PhD & Marshall H. Chin MD, MPH

  3. Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA

    Monica E. Peek MD, MPH, Michael T. Quinn PhD & Marshall H. Chin MD, MPH

  4. Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, IL, USA

    Monica E. Peek MD, MPH

  5. Section of Geriatrics and Palliative Care, Department of Medicine, University of Chicago, Chicago, IL, USA

    Rita Gorawara-Bhat PhD

  6. Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA

    Angela Odoms-Young PhD

Authors
  1. Monica E. Peek MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shannon C. Wilson MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rita Gorawara-Bhat PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angela Odoms-Young PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael T. Quinn PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marshall H. Chin MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monica E. Peek MD, MPH.

Additional information

An abstract of this work was presented at the Society of General Internal Medicine 31st Annual Meeting, Pittsburgh, PA, April 9–12, 2008.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Peek, M.E., Wilson, S.C., Gorawara-Bhat, R. et al. Barriers and Facilitators to Shared Decision-making Among African-Americans with Diabetes. J GEN INTERN MED 24, 1135–1139 (2009). https://doi.org/10.1007/s11606-009-1047-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-1047-0

KEY WORDS

Search

Navigation