User‐Centered Design of a Communication Tool to Address Diabetes Disparities in African American Communities

Abstract

Research ObjectiveAfrican Americans are disproportionately impacted by diabetes, with high rates of diabetes‐related morbidity and mortality. Despite the importance of addressing socio‐cultural factors in the clinical setting, many providers lack the expertise to effectively discuss these issues with patients. We examined patient and provider perspectives regarding patient‐provider communication about diabetes disparities to design a tool to facilitate discussions about diabetes health disparities.Study DesignWe used an iterative user‐centered design approach to develop a paper‐based diabetes disparities communication tool. The multidisciplinary project team included experts in family medicine, pharmacy, health disparities, public health, communications, health literacy and graphic design. We conducted a series of focus groups during 2017 and 2018: two with family medicine residents (n = 9) and four with patients with diabetes (n = 29). A semi‐structured interview guide explored participant perspectives on: (i) awareness of diabetes health disparities; (ii) patient‐provider communication about diabetes disparities; and (iii) a communication tool to facilitate patient‐provider communication about diabetes disparities. The communication tool prototype was iteratively updated and shared in subsequent focus groups for feedback on content and usage. Audio recordings of focus group discussions were transcribed, coded, and analyzed for themes using content analysis.Population StudiedFocus group participants were recruited from two family medicine practices (one urban and one suburban) with active residency programs affiliated with a large academic medical center in North Carolina. Participants included 9 family medicine residents at various stages of residency (4 female, 5 male) and 29 African American patients with diabetes (20 female, 9 male), who received care at the same practices.Principal FindingsKey themes from focus groups with residents included: (i) limited access to health disparities information; (ii) limited time to discuss health disparities with patients; (iii) need for easily accessible information; and (iv) experiential learning opportunities to build confidence in discussing health disparities. Key themes from focus groups with patients included: (i) benefit of discussing diabetes health disparities with their providers; (ii) value of a communication tool with actionable steps; (iii) use of imagery that reflects the diversity of African Americans; and (iv) community outreach to address health disparities. The final “Diabetes Health Disparities in African American Communities” communication tool provided information on health disparities statistics and social determinants of health. The tool also included a notes section to facilitate discussions about what the patient would like to work on and barriers to staying healthy.ConclusionsAfrican American patients and family medicine residents find value in discussing diabetes health disparities during the clinical encounter and perceive that a paper‐based communication tool with actionable steps can help facilitate those discussions. Both patients and residents perceive that activities outside of the clinical setting like community outreach are needed to enhance awareness of diabetes health disparities and social determinants of health, and improve community health.Implications for Policy or PracticeCommunication tools may help providers discuss diabetes health disparities with African American patients and provide the opportunity to address barriers to improved health. Future research should test this and similar tools in the clinical setting to determine effectiveness in clinical practice.Primary Funding SourceAtrium Health Center for Faculty Excellence.