Minority Health and Health Equity Archive

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The Effects of Financial Pressures on Adherence and Glucose Control Among Racial/Ethnically Diverse Patients with Diabetes
(2011) Ngo-Metzger, Quyen; Sorkin, Dara H.; Billimek, John; Greenfield, Sheldon; Kaplan, Sherrie H.
Abstract available at publisher's website.
Adherence to diabetes self-care behaviors in English- and Spanish-speaking Hispanic men.
(2009) Rustveld, Luis O; Pavlik, Valory N; Jibaja-Weiss, Maria L; Kline, Kimberly N; Gossey, J Travis; Volk, Robert J
We conducted a qualitative study to elicit attitudes, attributions, and self-efficacy related to diabetes self-care in both English- and Spanish-speaking Hispanic men. Transcripts from six focus groups (three in English and three in Spanish) were reviewed by the authors to extract principal and secondary themes. Participants could describe their medication and lifestyle regimens and were aware of whether they were adherent or nonadherent to physician recommendations. Lack of skills on how to incorporate diet and regular physical activity into daily living, lack of will power, and reluctance to change culturally rooted behaviors emerged as significant barriers to diabetes self-management. Medication adherence is for some men the principal diabetes self-care behavior. Nonadherence appeared to fit two profiles: 1) intentional, and 2) nonintentional. In both instances low self-efficacy emerged as a significant influence on attainment and maintenance of diabetes self-care goals. Participants also expressed a strong sense of fatalism regarding the course of their disease, and seemed to have little motivation to attempt long-term dietary control. Educational and counseling messages should stress that a diagnosis of diabetes is not a death sentence, and full functional capacity can be maintained with good control.
Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community
(2007) Casagrande, Sarah Stark; Gary, Tiffany L.; LaVeist, Thomas A.; Gaskin, Darrell J.; Cooper, Lisa A.
Background Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities. Objective To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community. Design A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study. Participants Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md. Measurements An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care. Results For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR]=1.8, 2.6; OR=2.2, 3.3, respectively; all P<.05). Results were similar for perceived discrimination occurring in the past year. Conclusions Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization.
Discrimination, Distrust, and Racial/Ethnic Disparities in Antiretroviral Therapy Adherence Among a National Sample of HIV-Infected Patients
(2008) Thrasher, Angela D.; Earp, Jo Anne L.; Golin, Carol E.; Zimmer, Catherine R.
Objective: Although discriminatory health care experiences and health care provider distrust have been shown to be associated with health care disparities, little is known about their contribution to racial/ethnic disparities in antiretroviral therapy adherence. We therefore sought to assess the extent to which discriminatory health care experiences and health care provider distrust influence treatmentrelated attitudes, beliefs, and self-reported adherence in a national sample of HIV-infected patients. Study Design: This secondary analysis used data from the HIV Cost and Services Utilization Study. We used structural equation modeling to identify pathways from minority status to adherence through discrimination, distrust, and treatment-related attitudes and beliefs. Participants: The sample was the 1886 participants who completed the baseline and 2 follow-up interviews and were prescribed antiretroviral therapy at the second follow-up interview (54% white, 28% black, 14% Hispanic, and 3% others). Results: Minorities were less likely to report perfect adherence than whites (40% vs. 50%, P # 0.001). Over one third (40%) of all participants reporting ever having discriminatory health care experiences since having HIV, and 24% did not completely or almost completely trust their health care providers. The effect of minority status on adherence persisted in the full model. More discrimination predicted greater distrust, weaker treatment benefit beliefs, and, in turn, poorer adherence. Distrust affected adherence by increasing treatment-related psychological distress and weakening treatment benefit beliefs. Conclusions: The relationship between minority status and adherence was not fully explained by patient-level factors. Future studies should consider conceptualizing minority status as a contextual factor rather than predictor.

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