University of Michigan School of Social Work, Ann Arbor, Michigan, USA
University of Michigan School of Social Work, Ann Arbor, Michigan, USA.
BMJ Open. 2024 Oct 1;14(10):e073689. doi: 10.1136/bmjopen-2023-073689.
There is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living with comorbid depression. This study aims to identify barriers and facilitators to mental healthcare utilisation among this population, guided by the theoretical domains framework (TDF).
This qualitative study involved 30 interviews with older African American adults diagnosed with T2D. The interview questions were aligned with TDF domains to capture participant perspectives on barriers and facilitators to mental healthcare use.
Interviews were conducted via telephone by a licensed clinician trained in social work. Each session lasted 60-90 min and was transcribed and analysed.
The study included 30 African American adults (15 males and 15 females), aged 60 and above, living in an urban area in the Midwest.
The primary outcome was the identification of themes from participant responses, analysed using thematic content techniques and categorised into TDF constructs. Demographic data served as the secondary outcome.
Nine key themes were identified, categorised under major TDF domains and constructs. Significant barriers included (1) systemic racism ('knowledge'), (2) normalisation of depressive symptoms ('beliefs about consequences'), (3) perceived stigma ('beliefs about consequences') and 4) costs of medications and healthcare ('environmental context and resources'). Facilitators to seeking mental healthcare included (1) empowerment ('beliefs about capabilities'), (2) perceived benefits of mental health exams ('beliefs about consequences'), (3) positive provider experiences ('reinforcement'), (4) recognition of depressive symptoms as a motivator ('goals') and (5) support networks ('social influences').
Key findings highlight that fostering positive patient-provider relationships and enhancing self-recognition of depressive symptoms can significantly encourage mental healthcare utilisation among older African Americans with T2D. These findings suggest that future interventions should focus on strengthening these relationships and improving self-awareness to better mental health outcomes.
针对可能患有或正在同时患有共病抑郁症的 2 型糖尿病（T2D）老年非裔美国人，研究旨在根据理论领域框架（TDF），确定他们在获取精神保健服务方面的障碍和促进因素。目前，针对这一人群的精神保健服务利用方面的研究还很少。
本定性研究纳入了 30 名被诊断患有 T2D 的老年非裔美国成年人。访谈问题与 TDF 领域相匹配，以了解参与者对精神保健服务使用的障碍和促进因素的看法。
由经过社会工作培训的持照临床医生通过电话进行访谈。每次访谈持续 60-90 分钟，并进行转录和分析。
该研究包括 30 名年龄在 60 岁及以上、居住在中西部城市地区的非裔美国成年人（男性 15 名，女性 15 名）。
主要结果是从参与者的回答中识别出主题，然后使用主题内容技术进行分析，并归入 TDF 结构。人口统计学数据作为次要结果。
确定了 9 个主要主题，分为主要 TDF 领域和结构。主要障碍包括（1）系统性种族主义（“知识”），（2）抑郁症状的正常化（“后果的信念”），（3）感知耻辱感（“后果的信念”）和 4）药物和医疗保健的成本（“环境背景和资源”）。寻求精神保健服务的促进因素包括（1）赋权（“能力的信念”），（2）对心理健康检查的益处的认识（“后果的信念”），（3）对提供者的积极体验（“强化”），（4）将抑郁症状识别为动机（“目标”），以及（5）支持网络（“社会影响”）。
主要发现强调，培养积极的医患关系和增强对抑郁症状的自我认知，可以显著鼓励 2 型糖尿病老年非裔美国人利用精神保健服务。这些发现表明，未来的干预措施应重点关注加强这些关系和提高自我意识，以改善心理健康结果。
