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WMJ Vol. 117 No. 5: Original Research

Cultural and Social Challenges of Diabetes Self-Management Education Through Physicians’ Voices

Laila Azam, PhD, MBA; John Meurer, MD, MBA; David Nelson, PhD; Onur Asan, PhD; Kathryn Flynn, PhD; Paul Knudson, MD; Staci Young, PhD



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Objective: The aim of this study is to understand how the physician-patient relationship is related to referral practices for diabetes self-management education and physicians’ perceptions of culturally competent health care delivery at a large health system affiliated with an academic medical center in a Midwestern city.

Methods: Sixteen physicians (6 family medicine, 6 internal medicine, 4 endocrinology) participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded. Data were thematically analyzed using MAXQDA software.

Results: All physicians considered diabetes self-management education a very important part of diabetes treatment, but physician referral patterns to diabetes education varied. Study findings indicated that both high and low referring physicians reported providing care that was responsive to personalized patient needs, including cultural beliefs, attitudes, and behaviors that affect health/health care. Building relationships and rapport with patients led to discussions of understanding barriers to diabetes management.

Conclusion: This study highlights physicians’ perceptions of and concerns about referrals to diabetes self-management education and the treatment of type 2 diabetes. Physicians understood the personal, environmental, and health care factors that limit the number of racial/ethnic minorities from participating.

Practice Implications: In addition to diabetes education, physicians suggested that additional resources or programs will help them address socioeconomic factors beyond their control and to understand cultural preferences.

Author Affiliations: Carroll University, Waukesha, Wis (Azam); Institute for Health and Equity, Medical College of Wisconsin (MCW) (Meurer); Department of Family and Community Medicine, MCW (Nelson, Young); Center for Patient Care and Outcomes Research, MCW (Asan, Flynn); Department of Medicine, Division of Endocrinology, MCW (Knudson); Milwaukee, Wis.

Corresponding Author: Laila Azam, PhD, MBA, Clinical Assistant Professor in Public Health Studies, Carroll University, 100 N East Ave, Waukesha, WI 53186; phone 414.737.3114; email lazam@carrollu.edu.

Acknowledgements: The authors would like to give a special thanks to Glenn Bushee (Medical Informatics Senior Analyst), Lisa Rein (biostatistician), Mary Conti, BSN, RN, and Chelsea Schreiber, MSN, RN, ACNS-BC, CDE, for their expertise and valuable assistance with this project.

Funding/Support: This study was partly funded by the Medical College of Wisconsin Advancing a Healthier Wisconsin endowment, specifically work by coauthors LA, SY, DN, and JM, transcriptions, and meals for participating physicians. Financial Disclosures: None declared.