Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
PLoS One. 2021 Dec 10;16(12):e0261030. doi: 10.1371/journal.pone.0261030. eCollection 2021.
Indigenous and other marginalized racial/ethnic minorities have poorer health status than majority populations, including higher rates of type 2 diabetes. These disparities have typically been addressed using a 'deficit-based' discourse that isolates disease management from the broader social, economic, political context and does not incorporate patient perspectives. We aimed to explore factors affecting glycemic control among Indigenous Arabs with diabetes in Israel using a strengths-based approach that centered participants' knowledge of their context, needs, resources and strengths. We conducted an exploratory sequential mixed methods study, which included 10 focus groups (5 men's, 5 women's) and 296 quantitative in-person surveys. Participants with diagnosed diabetes were randomly drawn from the patient list of the largest healthcare service organization (survey response rate: 93%). Prominent and interconnected themes emerged from focus group discussions, including: diet, physical activity, and social, economic, mental/psychological and political stress. The discussions raised the need for adapting diabetes management approaches to incorporate participants' communal, physical and psychological well-being, and socioeconomic/political realities. The connections between these factors and diabetes management were also reflected in multivariable analyses of the survey data. Women (OR: 2.03; 95% CI: 1.09-4.63), people with disabilities (OR: 2.43; 95% CI: 1.28-4.64), and unemployed people (OR: 2.64; 95% CI: 1.28-5.44) had higher odds of economic barriers to diabetes management. Furthermore, female sex (OR: 2.26; 95% CI: 1.25-4.09), unemployment (OR: 4.07; 95% CI: 1.64-10.10), and suboptimal glycemic control (OR: 1.20, 95% CI: 1.03-1.41 per 1-unit increase in HbA1c) were associated with moderate-to-severe depressive symptoms. A pro-active, team-based healthcare approach incorporating Indigenous/minority participants' knowledge, experience, and strengths has the potential to improve individuals' diabetes management. Healthcare services should be structured in ways that enable providers to listen to their patients, address their key concerns, and foster their strengths.
原住民和其他边缘化的种族/族裔少数群体的健康状况比多数人群差，包括更高的 2 型糖尿病发病率。这些差异通常是通过使用“基于缺陷”的论述来解决的，这种论述将疾病管理与更广泛的社会、经济、政治背景隔离开来，并且没有纳入患者的观点。我们旨在使用以参与者对其背景、需求、资源和优势的知识为中心的优势为基础的方法，探索影响以色列阿拉伯裔糖尿病患者血糖控制的因素。我们进行了一项探索性顺序混合方法研究，其中包括 10 个焦点小组（5 个男性，5 个女性）和 296 个现场定量调查。从最大的医疗保健服务组织的患者名单中随机抽取患有确诊糖尿病的参与者（调查响应率：93%）。焦点小组讨论中出现了突出且相互关联的主题，包括饮食、体育活动以及社会、经济、心理/心理和政治压力。讨论提出了需要调整糖尿病管理方法，以纳入参与者的社区、身体和心理健康以及社会经济/政治现实。这些因素与糖尿病管理之间的联系也反映在调查数据的多变量分析中。女性（OR：2.03；95%CI：1.09-4.63）、残疾人士（OR：2.43；95%CI：1.28-4.64）和失业人士（OR：2.64；95%CI：1.28-5.44）在糖尿病管理方面面临经济障碍的可能性更高。此外，女性性别（OR：2.26；95%CI：1.25-4.09）、失业（OR：4.07；95%CI：1.64-10.10）和血糖控制不理想（OR：1.20，95%CI：1.03-1.41，HbA1c 每增加 1 个单位）与中重度抑郁症状相关。一种积极主动、以团队为基础的医疗保健方法，结合原住民/少数民族参与者的知识、经验和优势，有可能改善个人的糖尿病管理。医疗服务的结构应使提供者能够倾听患者的意见，解决他们的主要关切，并培养他们的优势。
