Perceptions of culturally competent diabetes management in a primary care practice.

Abstract: To evaluate whether clinicians consider the impact of culture on diabetes management, a survey was mailed to 300 randomly selected patients ≥ 50 years with type 2 diabetes and 153 surveys were returned. Data were correlated with A1C values. African Americans (AA) and non-Hispanic whites (NHW), (91.9%, 97.0%) respectively, reported clinicians discussed benefits of controlling blood sugar but did not discuss effects of cultural issues on glucose control (≤. 50%). AAs perceived clinicians were more accommodating of their cultural preferences than did NHWs (49.2% versus 30.6%) (PKey Words: Communication; Culture; Diabetes; Disease Management; Disparities, Patient PerspectiveIntroductionThe prevalence of diabetes in the United States amounts to at least 25.8 million people (8.5%). Among U.S. residents aged 65 years and older, 10.9 million (26.9%), had diabetes in 2010 (CDC, 2011). Persons with diabetes will lose 10 to 15 life-years. (Narayan, Boyle, Thompson, Sorensen, & Williamson, 2003). A disparity of 0.65% in hemoglobin Ale (A1C) between African Americans (AA) and non-Hispanic whites (NHW) has been demonstrated in a metaanalysis among persons with diabetes and may provide a target for future interventions to reduce A1C and eliminate the excess microvascular complications in this population nationally. (Kirk et al., 2006). Minority Americans have been shown to have poorer health outcomes from preventable and treatable conditions including diabetes (Betancourt, 2006).Multiple studies show that some portion of health care outcomes disparities are due to ineffective patient-provider communication (Ashton et al., 2003; Cardarelli & Chiapa, 2007; Perloff, Bonder, Ray, Ray, & Siminoff, 2006). One study suggests that patient engagement and participation, rather than overall time spent, during medical visits may have a more ositive impact on addressing health disparities ohnson, Roter, Powe, & Cooper, 2004). Some research indicates that patients who assessed communication with their provider as poor had 1% higher mean A1C levels than those who assessed their patient-provider communication as good (Ciechanowski, Katon, Russo, & Walker, 2001). African American patients have been reported to have difficulty establishing a trust relationship with providers due to their perception that physicians are primarily profit driven (Jacobs, Rolle, Ferrans, Whitaker, & Warnecke, 2006; Miller, Seib, & Dennie, 2001). The effective use of culturally competent, patient-centered communication leads to improved physical and mental health status, fewer diagnostic tests and improved recovery (Franks et al., 2005; Stewart et al., 2000). Patients may have an easier time trusting their provider when they feel the provider has a genuine understanding of their illness ana how it affects their lives, which can result in less testing and need for specialists. (Bertakis, Azari, 2011).Health researchers have proposed that provider cultural competency may contribute to eliminating health disparities (Cardarelli & Chiapa, 2007). Understanding the patient's and clinician's views of cultural beliefs as they relate to diabetes selfmanagement can provide perspectives to guide care. We conducted a survey to assess patients' perspective of whether their clinicians employed culturally competent, patient-centered communication skills. A secondary purpose was to evaluate A1C in relationship to survey answers using the Disease Beliefs and Management Scale (DBMS) and the Cultural Concerns Scale (CCS) items for controlled A1C (