The main objective of this research is to examine self-reported racial discrimination in health care among adult American Indian (Al) women with diabetes from three Northwest (Oregon and Washington) reservation-based Indian health care facilities, and to estimate the association of discrimination and the use of medical services, diabetes-intermediate health outcomes and diabetes management.
Specific aims are: (1) to determine the prevalence of self-reported discrimination in health care;(2) to investigate the relationship between self-reported discrimination in health care with use of medical services;(3) to determine the relationship between self-reported discrimination in health care with intermediate health outcomes;and, (4) to examine the relationship between self-reported discrimination in health care with whether or not patient's meet nationally recommended cut-off points for optimal diabetes management status. A secondary objective of this research is to examine the relative strength of the association of perceived discrimination with insufficient diabetes control as compared to the strength of the associations for other risk factors. These potential risk factors include: (1) self-reported health status (measured by perceived health status and presence of co-morbidities);(2) opportunities for medical care (measured by health insurance coverage and continuity in medical care);(3) medical mistrust regarding health care systems and doctor(s) or medical provider(s);(4) confidence in doctor(s) or medical provider(s);and, (5) perceived treatment (as measured by perceived respectfulness) from non-medical staff. Health data will be collected from electronic records maintained at Indian health care facilities and will be used to document use of medical services, diabetes-intermediate health outcomes, and diabetes management status. Survey data and electronic health data will be linked for data entry and analysis. This research uses cross-section methods and involves administering a survey designed for this particular study. A minimum total sample of 200 individuals will be recruited to complete the survey. Research shows discrimination in health care is relevant to racial and ethnic populations, including those with diabetes, and negatively effects the health status and medical utilization within these populations. Few studies have been conducted among Als to document the prevalence of self-reported discrimination in health care, and none of these studies explore the association of discrimination on the persistent under-use of medical services and the insufficient diabetes management among this population. It is anticipated that this research will highlight new culturally relevant ways to target the diabetes epidemic with Als.
| Gonzales, Kelly L; Lambert, William E; Fu, Rongwei et al. (2014) Perceived racial discrimination in health care, completion of standard diabetes services, and diabetes control among a sample of American Indian women. Diabetes Educ 40:747-55 |
| Gonzales, Kelly L; Harding, Anna K; Lambert, William E et al. (2013) Perceived experiences of discrimination in health care: a barrier for cancer screening among American Indian women with type 2 diabetes. Womens Health Issues 23:e61-7 |
