Stuck in the Middle: A Mixed-Methods Study Examining the Role of Specific Health Knowledge and Perceived Risk in the African American Type 2 Diabetes Mellitus Health Disparity

Abstract

African Americans are disproportionately represented in the United States’ Type 2 Diabetes Mellitus (T2DM) statistics. This disparity has long been investigated, but no marked improvement has been made. This study examines knowledge gaps, perceptions of risk and conditions contributing to the persistence of this disparity, utilizing a mixed-methods approach.

This study examines T2DM knowledge and perceptions of risk in middle-class, African Americans living in New Orleans, Louisiana. Specifically, this study: 1) examines the T2DM prevention literature; 2) assesses knowledge levels, and perceptions of severity and susceptibility to T2DM in non-diabetic, or asymptomatic, middle-class African Americans; 3) explores the role of built environments on health behaviors; and 4) examines attitudes and feelings of self-efficacy in relation to preventative health strategies that may deter the development of T2MD.

This study found that the majority of the T2DM literature focused on the treatment of T2DM complications (n=177), not prevention of the disease (n=101). Study designs for T2DM prevention varied widely, from pilot and feasibility studies (n=9) to randomized control trials (n=10); the largest study type, however, was observational (n=19). None of the studies reviewed focused on middle-class African Americans. Income levels or socioeconomic status were largely unspecified (n=62).

The study did not find a correlation between participants’ perceptions of risk and actual risk, based on the ADA’s risk assessment (p =.110). There was a statistically significant, negative correlation (p = -.748) found between ADA risk totals and age, with significance set at the 0.01 level. There was also a statistically significant, negative correlation (p = -.214) found between T2DM risks and participant education levels, with significance set at the .05 level.

At large, participants expressed a perceived severity of T2DM. Participants noted, however, that the condition has become somewhat normalized in the African American community. Respondents generally felt sufficiently informed about the condition, which contributed to feelings of high self-efficacy and low levels of concern for developing T2DM. There were knowledge gaps and misinformation that provide grounds for re-evaluating those feelings, however.