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“IN SPITE OF THE SYSTEM”: A QUALITATIVE EXPLORATION OF HOW INNER-CITY AFRICAN AMERICAN ADULTS WITH TYPE 2 DIABETES NAVIGATE SOCIAL ENVIRONMENTAL BARRIERS TO HEALTH SELF-MANAGEMENT

Sage, Paulette Ann
http://rave.ohiolink.edu/etdc/view?acc_num=case1480938974286382

Abstract Details

2016, Doctor of Philosophy, Case Western Reserve University, Sociology.
“In Spite of the System”: A Qualitative Exploration of How Inner-City African American Adults with Type 2 Diabetes Navigate Social Environmental Barriers to Health Self-Management Abstract By PAULETTE ANN SAGE Purpose. This study was conducted to explore the barriers socioeconomically disadvantaged African American adults encounter in managing type 2 diabetes and the specific day-to-day strategies they employ to surmount them. Theoretical Framework. Four perspectives informed all aspects of this study, from crafting the research questions through interpretation of results: The agency vis-a-vis structure tension; Marxist/Conflict Theory; Constructivist Grounded Theory as explicated by Charmaz (2006), and several Social Ecological health models. Methods. Analysis was based on direct observation of 15 doctor/patient office visits and subsequent personal interviews. The patients were scheduled for routine follow-up visits and were selected from the panels of four physicians practicing at an exemplar (relatively high diabetes quality of care scores), safety-net clinic (>50% of patients on Medicaid or uninsured) in Northeast Ohio. Results. The most salient barriers patients faced in managing diabetes were economic, job, and insurance-related in nature; and these obstacles influenced all their health care decisions and behaviors. Other barriers included: managing comorbidities, food insecurity, scarcity of affordable exercise options, neighborhood crime, transportation 11 issues. Management strategies included: conferring regularly with their physicians; seeking the support of family, friends, and religion; going to a safety-net clinic; “listening to my body”; using trial and error to make self-management decisions; becoming informed; using available community resources; setting goals; and routinizing a diabetes regimen. Conclusion. Socioeconomically disadvantaged African American adults can successfully manage diabetes given the requisite resources: culturally competent, caring physicians and staff; the services of a safety-net healthcare system; public financial aid; information and education; and family and community support. Implications. This study is an exemplar for health stakeholders who seek to foster productive doctor/patient relationships and to improve diabetes outcomes of socioeconomically disadvantaged populations. Study findings suggest several policy implications: increasing the time for routine visits with complex patients; incentivizing caring and meaningful doctor/patient relationships over quantitative “throughput” measures; incentivizing integrative whole person care; systematically assessing patients’ social environmental concerns; and offering medical students mentored experiences in international health to foster altruistic caring (Bolen, Sage, Perzynski, & Stange, 2015; Ferrer & Carrasco, 2010; Epstein et al, 2010; Berenson & Rich, 2010; Hong et al., 2010).
Brian Gran, Ph.D. (Committee Chair)
421 p.
Sociology
social determinants of health, health disparities, African Americans, type 2 diabetes

Recommended Citations

Citations

  • Sage, P. A. (2016). “IN SPITE OF THE SYSTEM”: A QUALITATIVE EXPLORATION OF HOW INNER-CITY AFRICAN AMERICAN ADULTS WITH TYPE 2 DIABETES NAVIGATE SOCIAL ENVIRONMENTAL BARRIERS TO HEALTH SELF-MANAGEMENT [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1480938974286382

    APA Style (7th edition)

  • Sage, Paulette. “IN SPITE OF THE SYSTEM”: A QUALITATIVE EXPLORATION OF HOW INNER-CITY AFRICAN AMERICAN ADULTS WITH TYPE 2 DIABETES NAVIGATE SOCIAL ENVIRONMENTAL BARRIERS TO HEALTH SELF-MANAGEMENT. 2016. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1480938974286382.

    MLA Style (8th edition)

  • Sage, Paulette. "“IN SPITE OF THE SYSTEM”: A QUALITATIVE EXPLORATION OF HOW INNER-CITY AFRICAN AMERICAN ADULTS WITH TYPE 2 DIABETES NAVIGATE SOCIAL ENVIRONMENTAL BARRIERS TO HEALTH SELF-MANAGEMENT." Doctoral dissertation, Case Western Reserve University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1480938974286382

    Chicago Manual of Style (17th edition)

case1480938974286382
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© 2016, some rights reserved.Creative Commons License “IN SPITE OF THE SYSTEM”: A QUALITATIVE EXPLORATION OF HOW INNER-CITY AFRICAN AMERICAN ADULTS WITH TYPE 2 DIABETES NAVIGATE SOCIAL ENVIRONMENTAL BARRIERS TO HEALTH SELF-MANAGEMENT by Paulette Ann Sage is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.