Individual-,Community-,and Health System–Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development
Restricted accessReview articleFirst published online February, 2020
Individual-,Community-,and Health System–Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development
The purpose of this integrative review is (1) to elucidate the unique barriers faced by inner-city African Americans for type 2 diabetes (T2DM) care; (2) to identify effective interventions/programs for optimal T2DM care at the individual, community, and health systems levels; and (3) to integrate 2 behavioral models and 1 social ecological model for framing interventions for inner-city African American to optimize T2DM care.
Methods
PRISMA guidelines were followed to systematically search PubMed, PsychInfo, and CINAHL. Integration of models was based on underlying principles of social ecological models.
Results
The search returned 1183 articles. Forty-six articles were synthesized after applying inclusion criteria. Multiple barriers for the individual level, community level, and health system level were identified. Major barriers include lack of knowledge, lack of social support, and self-management support. Interventions identified in this review show that among inner-city African Americans with T2DM, the focus is placed at the health systems level, with very limited focus toward addressing individual- and community-level barriers. Final synthesis includes development of a new integrated model that explains barriers to care across multiple levels.
Conclusions
These findings highlight the fragmentation that may be occurring between policy, research, and practice for achieving health equity and addressing health disparities for T2DM care among inner-city African Americans. The new model is an important step in the pursuit of equity in T2DM by specifying the complex barriers that occur across multiple levels. The application of this model using the 2017 National Standards for Diabetes–Self Management Education and Support are discussed.
Get full access to this article
View all access options for this article.
References
1.
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention; 2017.
2.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S13-S28.
3.
Centers for Disease Control and Prevention. Diabetes Report Card, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2018.
4.
American Diabetes Association. 3. Prevention or delay of type 2 diabetes: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S29-S33.
United States Renal Data System. USRDS 2016 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2016.
7.
BachmannMOEachusJHopperCD, et al. Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med. 2003;20(11):921-929.
8.
GaskinDJThorpeRJJrMcGintyEE, et al. Disparities in diabetes: the nexus of race, poverty, and place. Am J Public Health. 2014;104(11):2147-2155.
9.
BretonMCGuénetteLAmicheMAKayibandaJFGrégoireJPMoisanJ. Burden of diabetes on the ability to work: a systematic review. Diabetes Care. 2013;36(3):740-749.
10.
GebreabSYHicksonDASimsM, et al. Neighborhood social and physical environments and type 2 diabetes mellitus in African Americans: the Jackson Heart Study. Health Place. 2017;43:128-137.
11.
RyanAMGeeGCGriffithD. The effects of perceived discrimination on diabetes management. J Health Care Poor Underserved. 2008;19(1):149-163.
12.
BrownAFGreggEWStevensMR, et al. Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2005;28(12):2864-2870.
13.
American Diabetes Association. 1. Improving care and promoting health in populations: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S7-S12.
14.
BainsSSEgedeLE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes Technol Ther. 2011;13(3):335-341.
15.
EgedeLEBonadonnaRJ. Diabetes self-management in African Americans: an exploration of the role of fatalism. Diabetes Educ. 2003;29(1):105-115.
16.
Den BraverNRLakerveldJRuttersFSchoonmadeLJBrugJBeulensJW. Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med. 2018;16(1):12.
17.
AuchinclossAHRouxAVBrownDGErdmannCABertoniAG. Neighborhood resources for physical activity and healthy foods and their association with insulin resistance. Epidemiology. 2008;1:146-157.
18.
ZiemerDCEl-KebbiIMUmpierrezGERheeMKPhillipsLSCookCB. Diabetes management in urban African Americans: review of a public hospital experience. Ethn Dis. 2008;18(3):336-341.
19.
ZhangXBullardKMGreggEW, et al. Access to health care and control of ABCs of diabetes. Diabetes Care. 2012;35(7):1566-1571.
20.
Ricci-CabelloIRuiz-PérezINevot-CorderoARodríguez-BarrancoMSordoLGonçalvesDC. Health care interventions to improve the quality of diabetes care in African Americans: a systematic review and meta-analysis. Diabetes Care. 2013;36(3): 760-768.
21.
Initiative for a Competitive Inner City. What is an inner city?2019. http://icic.org.
22.
NoonanASVelasco-MondragonHEWagnerFA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37(1):12.
23.
StokolsD. Establishing and maintaining healthy environments: toward a social ecology of health promotion. Am Psychol. 1992;47(1):6-22.
24.
GlanzKRimerBKViswanathK, eds. Health Behavior and Health Education: Theory, Research, and Practice. Hoboken, NJ: John Wiley & Sons; 2008.
25.
BrownAFEttnerSLPietteJ, et al. Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev. 2004;26(1):63-77.
26.
WagnerEHAustinBTDavisCHindmarshMSchaeferJBonomiA. Improving chronic illness care: translating evidence into action. Health Affairs. 2001;20(6):64-78.
27.
SmallsBLGregoryCMZollerJSEgedeLE. Conceptualizing the effect of community and neighborhood factors on type 2 diabetes health outcomes. Environ Behav. 2017;49(5):560-582.
28.
WalkerRJGebregziabherMMartin-HarrisBEgedeLE. Relationship between social determinants of health and processes and outcomes in adults with type 2 diabetes: validation of a conceptual framework. BMC Endocr Disord. 2014;14(1):82.
29.
AlvidrezJCastilleDLaude-SharpMRosarioATaborD. The national institute on minority health and health disparities research framework. Am J Public Health. 2019;109(S1):S16-S20.
30.
BaptistaDRWiensAPontaroloRRegisLReisWCCorrerCJ. The chronic care model for type 2 diabetes: a systematic review. Diabetol Metab Syndr. 2016;8(1):7.
31.
SouzaMTSilvaMDCarvalhoRD. Integrative review: what is it? How to do it?Einstein (São Paulo). 2010;8(1):102-106.
32.
MoherDShamseerLClarkeM, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.
33.
WhittemoreRKnaflK. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-553.
34.
BalukonisJMelkusGDChyunD. Grandparenthood status and health outcomes in midlife African American women with type 2 diabetes. Ethn Dis. 2008;18(2):141-146.
35.
BattsMLGaryTLHussKHillMNBoneLBrancatiFL. Patient priorities and needs for diabetes care among urban African American adults. Diabetes Educ. 2001;27(3):405-412.
36.
CalvinDQuinnLDancyB, et al. African Americans’ perception of risk for diabetes complications. Diabetes Educ. 2011;37(5):689-698.
37.
CarterELNunlee-BlandGCallenderC. A patient-centric, provider-assisted diabetes telehealth self-management intervention for urban minorities. Perspect Health Inf Manag. 2011;8:1b.
38.
ChardSHarris-WallaceBRothEG, et al. Successful aging among African American older adults with type 2 diabetes. J Gerontol B Psychol Sci Soc Sci. 2017;72(2):319-327.
39.
ChlebowyDOHoodSLaJoieAS. Facilitators and barriers to self-management of type 2 diabetes among urban African American adults. Diabetes Educ. 2010;36(6):897-905.
40.
CookCBLylesRHEl-KebbiI, et al. The potentially poor response to outpatient diabetes care in urban African-Americans. Diabetes Care. 2001;24(2):209-215.
41.
CookCBHentzJGTsuiCZiemerDCNaylorDBMillerWJ. Poor glycemic control increases risk of hospitalization in urban African Americans with diabetes. Ethn Dis. 2006;16(4):880-885.
42.
CrabtreeKSherrerNRushtonT, et al. Diabetes connect: African American men’s preferences for a community-based diabetes management program. Diabetes Educ. 2015;41(1):118-126.
43.
DalewitzJKhanNHersheyCO. Barriers to control of blood glucose in diabetes mellitus. Am J Med Qual. 2000;15(1):16-25.
44.
de GrootMWelchGFergusMRuggieroLChipkinSR. Cultural orientation and diabetes self-care in low-income African Americans with type 2 diabetes mellitus. Ethn Dis. 2003;13(1):6-14.
45.
DeNiscoS. Exploring the relationship between resilience and diabetes outcomes in African Americans. J Am Acad Nurse Pract. 2011;23(11):602-610.
46.
El-KebbiIMBachaGAZiemerDC, et al. Diabetes in urban African Americans. V. Use of discussion groups to identify barriers to dietary therapy among low-income individuals with non-insulin-dependent diabetes mellitus. Diabetes Educ. 1996;22(5): 488-192.
47.
El-KebbiIMZiemerDCMuseyVCGallinaDLBernardAMPhillipsLS. Diabetes in urban African-Americans. IX. Provider adherence to management protocols. Diabetes Care. 1997;20(5): 698-703.
48.
El-KebbiIMCookCBZiemerDCMillerCDGallinaDLPhillipsLS. Association of younger age with poor glycemic control and obesity in urban African Americans with type 2 diabetes. Arch Intern Med. 2003;163(1):69-75.
49.
ErdmanDMCookCBGreenlundKJ, et al. The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. Diabetes Care. 2002;25(1):9-15.
50.
FitzpatrickSLGoldenSHStewartK, et al. Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) program delivery modalities on clinical and behavioral outcomes in urban African Americans with type 2 diabetes: a randomized trial. Diabetes Care. 2016;39(12):2149-2157.
51.
GaryTLCrumRMCooper-PatrickLIFordDBrancatiFL. Depressive symptoms and metabolic control in African-Americans with type 2 diabetes. Diabetes Care. 2000;23(1):23-29.
52.
GaryTLBatts-TurnerMYehHC, et al. The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2009;169(19):1788-1794.
53.
GongLKaoWHBrancatiFLBatts-TurnerMGaryTL. Association between parental history of type 2 diabetes and glycemic control in urban African Americans. Diabetes Care. 2008;31(9):1773-1776.
54.
Hill-BriggsFGaryTLHillMNBoneLRBrancatiFL. Health-related quality of life in urban African Americans with type 2 diabetes. J Gen Intern Med. 2002;17(6):412-419.
55.
Hill-BriggsFCooperDCLomanKBrancatiFLCooperLA. A qualitative study of problem solving and diabetes control in type 2 diabetes self-management. Diabetes Educ. 2003;29(6):1018-1028.
56.
Hill-BriggsFGaryTLBoneLRHillMNLevineDMBrancatiFL. Medication adherence and diabetes control in urban African Americans with type 2 diabetes. Health Psychol. 2005;24(4):349-357.
57.
Hill-BriggsFGaryTLYehHC, et al. Association of social problem solving with glycemic control in a sample of urban African Americans with type 2 diabetes. J Behav Med. 2006;29(1):69-78.
58.
JaberLAHalapyHFernetMTummalapalliSDiwakaranH. Evaluation of a pharmaceutical care model on diabetes management. Ann Pharmacother. 1996;30(3):238-243.
59.
LeeLTWilligALAgneAALocherJLCherringtonAL. Challenges to healthy eating practices: a qualitative study of non-Hispanic black men living with diabetes. Diabetes Educ. 2016; 42(3):325-335.
60.
MancusoJM. Impact of health literacy and patient trust on glycemic control in an urban USA population. Nurs Health Sci. 2010;12(1):94-104.
61.
MbaezueNMayberryRGazmararianJQuarshieAIvonyeCHeislerM. The impact of health literacy on self-monitoring of blood glucose in patients with diabetes receiving care in an inner-city hospital. J Natl Med Assoc. 2010;102(1):5-9.
62.
McDonaldPEWykleMLMisraRSuwonnaroopNBurantCJ. Predictors of social support, acceptance, health-promoting behaviors, and glycemic control in African-Americans with type 2 diabetes. J Natl Black Nurses Assoc. 2002;13(1):23-30.
63.
MillerCDBarnesCSPhillipsLS, et al. Rapid A1C availability improves clinical decision-making in an urban primary care clinic. Diabetes Care. 2003;26(4):1158-1163.
64.
MusselmanDLZiemerDCMcNuttMD, et al. Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes. J Psychiatr Res. 2014;52:21-27.
65.
PearteCAGaryTLBrancatiFL. Correlates of physical activity levels in a sample of urban African Americans with type 2 diabetes. Ethn Dis. 2004;14(2):198-205.
66.
PollardSLZacharyDAWingertKBookerSSSurkanPJ. Family and community influences on diabetes-related dietary change in a low-income urban neighborhood. Diabetes Educ. 2014;40(4):462-469.
67.
Ramsay WanCVoLBarnesCS. Conceptualizations of patient empowerment among individuals seeking treatment for diabetes mellitus in an urban, public-sector clinic. Patient Educ Couns. 2012;87(3):402-404.
68.
RheeMKCookCBDunbarVG, et al. Limited health care access impairs glycemic control in low income urban African Americans with type 2 diabetes. J Health Care Poor Underserved. 2005;16(4):734-746.
69.
RheeMKCookCBEl-KebbiI, et al. Barriers to diabetes education in urban patients perceptions, patterns, and associated factors. Diabetes Educ. 2005;31(3):410-417.
70.
RichardsonBSWilligALAgneAACherringtonAL. Diabetes connect: African American women’s perceptions of the community health worker model for diabetes care. J Community Health. 2015;40(5):905-911.
71.
ShawBAGallantMPRiley-JacomeMSpokaneLS. Assessing sources of support for diabetes self-care in urban and rural underserved communities. J Community Health. 2006;31(5):393-412.
72.
SkellyAHMarshallJRHaugheyBPDavisPJDunfordRG. Self-efficacy and confidence in outcomes as determinants of self-care practices in inner-city, African-American women with non-insulin-dependent diabetes. Diabetes Educ. 1995;21(1):38-46.
73.
SpencerMSRoslandAMKiefferEC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101(12):2253-2260.
74.
WagnerJAOsbornCYMendenhallEABudrisLMBelaySTennenHA. Beliefs about racism and health among African American women with diabetes: a qualitative study. J Natl Med Assoc. 2011;103(3):224-233.
75.
WallaceBHReeseAMChardSRothEGQuinnCEckertJK. Understanding the subjective experience of medication adherence for older urban African Americans with type 2 diabetes and a history of illicit drug addiction. J Aging Health. 2017;29(3):489-509.
76.
WankoNSBrazierCWYoung-RogersD, et al. Exercise preferences and barriers in urban African Americans with type 2 diabetes. Diabetes Educ. 2004;30(3):502-513.
77.
WelchGBalderAZagarinsS. Telehealth program for type 2 diabetes: usability, satisfaction, and clinical usefulness in an urban community health center. Telemed J E Health. 2015;21(5): 395-403.
78.
ZiemerDCGoldschmidMGMuseyVC, et al. Diabetes in urban African Americans. Management of type II diabetes in a municipal hospital setting. Am J Med. 1996;101(1):25-33.
79.
ZiemerDCBerkowitzKJPanayiotoRM, et al. A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes. Diabetes Care. 2003;26(6):1719-1724.
80.
HobfollSE. The Ecology of Stress. New York, NY: Taylor & Francis; 1988.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
