Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders
Abstract
:1. Introduction
2. Materials and Methods
2.1. Description of the Peers EXCEL Intervention
2.2. Research Design
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Brief Description of Participants
3.2. Key Stakeholders’ Perspectives of Peers EXCEL
3.2.1. Fulfill Current Needs among Stakeholders
“[HLWD] is really open to anyone in our community. So, we don’t limit it to just those who get care at [this specific health system]. I think it’s really important to get them that education if they can’t afford it, they don’t have access.”—PHS 4
“Our location was centrally located in the community. We had an open-door policy with our residents. We were able to provide all the ingredients of a successful workshop…So definitely making sure that we offer multiple times for participants is one of the things and making sure that a snack or a meal of some sort is provided is the other…coordinating transportation is not necessarily the primary focus.”—PHS 1
3.2.2. Creating a Supportive and Trusting Environment to Address Distrust
“With the peer support, they can get into more specific issues if they are really having troubles with maintaining their diet or maintaining their medications… they would have someone that they can voice their concerns to plus someone who would be there that can give them pointers on how to get around it. Just having the classes alone, you might get that, but a more one-on-one would, give that extra level of support.”—HCP 6 (Pharmacist)
“I do think that [Peers LEAD] was able to let the participant have more of a voice, exploring their perceptions and their ideas related to how they handle their diabetes. I think that is very, very good …. I know the other program has more structured sessions, which sometimes the timeline gets to be a little bit short for really letting people really understand those areas. So I think that maybe having that peer support in between could help reinforce some of those concepts that might not be able to be put in the actual class sessions….”—HCP 2 (Nutritionist)
3.2.3. Building Relationships and Empowering Peers
“In HLWD, they share their struggles, they really feel connected to others in the class. They’re not in this battle alone. They have others they can reach out to that know what it’s like to live with diabetes”—PHS 4
“I think it’s going to help a lot with self-management, and eventually that gets reflected into an A1c... Really, it’s about adapting a healthier lifestyle, which is more important than just an A1c., it’s going to help with patient engagement. And that is one of the first steps in improving diabetes care.”—HCP 7 (Provider)
“We recognize it’s important that individuals that want to have better management of their lives learn from their peers and individuals that can resonate with their story.”—PHS 1
3.2.4. Logistical Organization Barriers to Program Implementation
“The position of the coordinator role is not a state-mandated service at this time, and so it’s unlikely that more resources will be allocated to that position, and there is no capacity for that coordinator to increase time and do more programs than what we already have.”—PHS-3
“...in general, it’s time, work schedule. You know, some people are working the second shift or third shift. These are the barriers that they may not participate in the program.”—HCP 6 (Pharmacist)
3.2.5. Challenges to Program Acceptance by Participants
“It would be really nice if we could reach out to our African American community in [a city in Midwest], our surrounding areas, and ask them what they’re comfortable with… Are you comfortable coming in to take a class inside the healthcare setting, or would you rather have it within your community?”—PHS 4
“...a lot of my patients do have difficulty getting transportation. So I think that might be a barrier.”—HCP 3 (Pharmacist)
“[Patients] may be more willing to come if they really trust the people that’s involved in it. So, who’s leading the program, how the outreach is, those can either enhance or can be barriers to participation. But if someone that you know and trust asks you to do it, you’re more apt to do it.”—HCP 2 (Nutritionist)
“It would be really nice if we could reach out to our African American community in (a Mid- Western County), our surrounding areas, and ask them what they’re comfortable with… Are you comfortable coming in to take a class inside the healthcare setting, or would you rather have it within your community?”—PHS 44. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Healthcare Professionals | |
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Domain: Meeting the needs of the African American patient population with type 2 diabetes | |
How well do you think Peers EXCEL implemented in the community would meet the needs of African Americans with diabetes in your organization? | |
Case: Imagine you are working with an African American patient who had been diagnosed with diabetes for over 5 years and was struggling to bring down their A1C. What challenges do you see patients like this facing? What are they lacking? | |
How do you think African Americans served by your organization will respond to your Peers EXCEL? | |
What barriers will African Americans with diabetes served by your organization face to participating in the Peers EXCEL program? | |
Domain: Identifying organizational factors that might influence Peers EXCEL implementation and effectiveness | |
Tell me about what your organization currently offers related to diabetes self-management services for patients. (Adapted to align with each type of HCP) | |
How is Peers EXCEL similar or different than other similar existing programs in your setting? | |
How does Peers EXCEL align with your organization’s goals? | |
Would you be willing to refer African American patients with diabetes who are having challenges with taking medicines to a program, such as Peers EXCEL in the community? | |
Is there anything you feel is missing from Peer EXCEL that would make it more effective? | |
Organizational Leaders | |
Domain: Organization’s experience with hosting HLWD (past host sites) | |
Tell me about your organization’s experience with hosting HLWD | |
Tell me how/why your organization first become involved with hosting HLWD. | |
Tell me what made it convenient for your clientele or community to attend the HLWD sessions. | |
Tell me about the barriers that people faced in attending HLWD sessions. | |
Domain: Organizational goals or activities related to health & diabetes | |
Is Peers EXCEL consistent with your organization’s goals? (both) | |
Tell me what your organization currently has in terms of health programs or ministries. (Future host sites) | |
Tell me about what makes it convenient for your clientele/community to attend these programs/meetings. (Future host sites) | |
Tell me about any barriers that people face to attending these programs/meetings. (Future host sites) | |
In what way could Peers EXCEL be useful to the population your organization serves? (both) | |
How do you think African Americans with diabetes served by your organization would respond to Peers EXCEL? (Future host sites) | |
What do you see as the gaps in diabetes self-management for African Americans in your community? (Future host sites) | |
Domain: Interest in hosting Peers EXCEL (both) | |
Do you think your organization would be interested in hosting Peers EXCEL in the future? | |
What would it take for your organization to be interested in this idea? | |
Domain: Identifying logistical factors that might influence hosting the new program at the organization (both) | |
What would your organization need to make hosting Peers EXCEL work? | |
How would your organization offer/tailor Peers EXCEL to work in your setting? | |
Tell me about the barriers or challenges you think there might be for your organization to host Peers EXCEL. | |
What barriers would African Americans with diabetes served by your organization face to participating in Peers EXCEL? |
Characteristic | |
---|---|
Healthcare Professionals | n = 7 |
Pharmacist | 4 |
Provider | 1 |
Nutritionist | 1 |
Diabetes Educator | 1 |
Organizational Leaders | n = 6 |
Past Host Site | |
Health System | 2 |
Non-profit Organization | 1 |
County Agency | 1 |
Future Host Site | |
Church | 1 |
Senior Housing Complex | 1 |
Type | |
Black-serving Organization | 4 |
Not Black-serving Organization | 2 |
Themes | Subthemes and Quotes |
---|---|
Fulfill needs among stakeholders | Program aligns with organizational goals and mission “Well, my particular organization’s goal is to reach as many people as possible to help them live long and healthy and productive lives. And this program feeds right into it because of... my commitment to diabetes from the standpoint that many African Americans don’t get the same type of education around health and health literacy. And this program would definitely go a long way to meeting that goal…”—HCP 2 (Nutritionist) “My biggest concern is that they’re [rationing diabetes] medicines, which is shortening the supply of the person [from whom they are borrowing medication] …I bring somebody in to talk about the medication, like what happens when you do that, what happens to your body because you’re not getting the full amount that you need so that you could be sustained….They’ll sit and take the time to answer any questions that they have about their medications or about health conditions... So, you can’t beat that, the pharmacist coming to you.”—FHS 2 |
Low capacity of health system increases the need for and relevance of the program “In a clinical setting, as a provider, we have very limited time to provide education on diet and exercise and all of that counseling that comes along with it that oftentimes we have to ask colleagues to help like diabetic educators, nutritionists. And that can lead to more of a broken treatment or fragmented, so it can leave patients feeling very frustrated.”—HCP 7 (Provider) “Having an additional program complement [HCP education], with bringing in details about culture, cultural experiences, because unfortunately, I’m not in that culture. I did not grow up African American, so I don’t fully understand it. I think it’s a complement to really help with the management and help them see a side that I would not be able to necessarily present to them.”—HCP 5 (Pharmacist) | |
Strengths from Leveraging HLWD Program Infrastructure “We have a partnership with Wisconsin Institute for Healthy Aging, which is the state license holder [for HLWD] …we thought it would be a good option to expand, and there are a couple of extra tools that are specific to diabetes. So, we saw the need because of the clientele we were already serving, and it was well received.”—PHS 3 “We’ve also partnered with a food co-op. We’ve held [meetings] in a food co-op learning room, which has been really beneficial because then you have the groceries, then [participants] can seek out some healthy snacks.”—PHS 4 | |
Creating a supportive and trusting environment to address distrust | Helps further facilitate trust and provides a safe space for participants “When you have a program that is primarily developed around interacting people of color with people of color, that breaks down some of their barriers, and people are able to have a safe space for telling their truth… also [the] trust factor would be so much better. … [Peers] LEAD I feel is way more sensitive to African Americans’ feelings and, the idea that they really can share, more open to sharing themselves.”—HCP 2 (Nutritionist) “There are a lot of literacy issues, and people have problems understanding the machines that they use or how to do it and questions about their insulin or their medications. And they don’t always understand what the doctors are saying, so they need reinforcement to help them understand what the doctor wants them to do.”—FHS 1 |
Provide additional opportunities to discuss disease-related topics with HCPs “And the more we can educate patients because sometimes the first time they hear it, it’s not motivating. Or they’re in denial yet about having their diabetes. the more that we can hit home and focus on those education pieces, the better. I think this combination would work really well and be very successful for the community of patients that I’ve personally seen. …And I thought it [Peers LEAD] was a really great opportunity to get to know, and maybe break down some barriers or some myths that are within the African American community about medications.”—HCP 3 (Pharmacist) “They want to know about these different things (content of Peers EXCEL) so maybe this is something that will be better for them. They can go back and tell their doctors… They will listen, and they’re definitely going to ask questions. I think that they would enjoy it.”—FHS 2 | |
Building relationships and empowering peers | Connection and motivation embedded into the program “I think [participants] will respond well, because it’s not one-sided... how it’s presented to them is that we’re in this together having all the pieces that go together will have someone feeling like they are connected. And they feel like there’s something out there that’s going to help them, because they want to make their lives better... The compassion of the program makes a huge difference, rather than just being a program that has written things, there is an emotional connection to it. that makes a difference.” HCP 1 (Diabetes Educator) “In my experience, African Americans have such a [bias] around eating and family, and their culture is based in that, a lot of them struggle with making healthy decisions and how to adapt a healthier eating style compared to previous. So many of my patient’s report, I want my fried chicken. That’s just what I have to eat. I want my collard greens. I want my corn bread. So I feel really incorporating that, and then potentially having a peer group where they can talk about that, how they address it and what options and opinions they can use for support would be very beneficial.”—HCP 5 (Pharmacist) “it’s kind of like you’re walking around with someone who can relate to you, so you don’t feel like you’re by yourself. And I think that is the biggest advantage of this program, is to have something that is peer led….”—HCP 1 (Diabetes Educator) “I was highlighting that one of the things that we really appreciate or the concept for integrating Peers LEAD with the self-management diabetes workshop is because part of that work is to have those regular engagements with participants…The Peers leading Peers will provide support in following up with those individuals and building that rapport along with the leader so that is more manageable.”—PHS 1 Provides peer support that reinforces self-management advice from healthcare providers “The biggest [benefit] with the combined program would be having the Peer Ambassadors, the peer supports. that is different because many of the programs, people come, they hear a speaker, and they may be able to talk to other people, but then they go home. They don’t have any follow-up., that peer support, that person that they can actually ask additional questions to and have a conversation, I think that makes it much different. It can really build trust and trust that the individuals working with them understand their particular situation. …having that peer support person who understands, what people go through, is a very important thing.”—HCP 2 (Nutritionist) “I think sometimes it’s easy for patients to just see healthcare providers as someone who’s like telling you what to do. And I think having that [peer] mentor, is going to be huge to help patients to get motivated and, and truly see the importance of taking care of themselves…having someone in the community that they can relate to, reiterate those same things, would have an impact and maybe it would hit home a little bit more than just a provider telling them that.”—HCP 3 (Pharmacist) “With the peer support, they can get into more specific issues if they are really having troubles with maintaining their diet or maintaining their medications… they would have someone that they can voice their concerns to, plus someone who would be there that can give them pointers on how to get around it… more one-on-one would, give that extra level of support.”—HCP 6 (Pharmacist) |
Logistical organization barriers to program implementation | Lack of capacity and resources for program “For us to facilitate the workshop as an agency, is much more taxing than to have the community facilitate the workshops... For our community-based organizations that host, they usually already have a population to be served. So it minimizes the work needed around recruitment and promoting. They facilitate that or help to support the facilitation of that.”—PHS 1 “We would need a dedicated staff to do this work… if you’re doing recruitment, set-up and coordinating food. You’re making sure that you can have that guidance…. It can be a lot of heavy lifting.”—PHS 1 “It would be getting other people trained to host the program… We just don’t have a staff for that. It’s very time consuming and we need the staff. And right now, everything is with COVID”—PHS 2 “We recognize that sometimes when we’re talking about healthy eating, individuals don’t have access to healthy items. And so, making sure that we can coordinate that [with a partner organization] on behalf of participants is something else that we think is a huge opportunity when facilitating a workshop but requires a lot of time”—PHS 1 |
Challenges to program acceptance by participants | Perceived barriers in recruiting participants “People have fear about diseases and what they’re going to find or what the doctor is going to do or not do. Put you on a medication, it’s always fear of the unknown”—PHS 2 “I think with any population, you know, access to care. If they’re not familiar or comfortable with the healthcare setting. Maybe they’re not getting the care that they need right now”—PHS 4 “I think the biggest barrier is really people knowing about the program. We really do a wide variety of outreach strategies, but still, I think not everybody knows of our programs, and that’s always a factor. We want people to hear about it…”—PHS 3 Making participation convenient “Making sure that we offer multiple times for participants is one of the things and making sure that a snack or a meal of some sort is provided is the other. But coordinating transportation is not necessarily the primary focus. Although when needed, it was something that we helped to provide support on.”—PHS 1 “They’re free. So there isn’t that cost barrier…. churches and that sort of thing or other sites that would want to host it”—PHS 1 “The participants pay $10 (for the program) …It used to be free. I opened it up free, but then I’d have everyone sign up…the first day I would have like four people. This is too easy not to show up. If you put some monetary value to it, I see there’s a little better commitment.”—PHS 2 Increasing community awareness of the program “Having it being known and having that success behind you and having some program ambassadors that have taken this program as great word of mouth that, you know, this is great. You should do it too, you know, that kind of thing.”—PHS 3 “We sometimes call the physician. But again, they have to be reminded to tell their diabetic patients that we offer this class. And I work with the diabetic educators as well, telling them we have this class. So we try to cross as many paths as possible to get people involved to take it”–PHS-2 |
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Wen, M.-J.; Maurer, M.; Schwerer, L.; Sarkarati, N.; Egbujor, U.M.; Nordin, J.; Williams, S.D.; Liu, Y.; Shiyanbola, O.O. Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders. Int. J. Environ. Res. Public Health 2022, 19, 12814. https://doi.org/10.3390/ijerph191912814
Wen M-J, Maurer M, Schwerer L, Sarkarati N, Egbujor UM, Nordin J, Williams SD, Liu Y, Shiyanbola OO. Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders. International Journal of Environmental Research and Public Health. 2022; 19(19):12814. https://doi.org/10.3390/ijerph191912814
Chicago/Turabian StyleWen, Meng-Jung, Martha Maurer, Luke Schwerer, Nassim Sarkarati, Ugboaku Maryann Egbujor, Jenna Nordin, Sharon D. Williams, Yao Liu, and Olayinka O. Shiyanbola. 2022. "Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders" International Journal of Environmental Research and Public Health 19, no. 19: 12814. https://doi.org/10.3390/ijerph191912814