Managing Type 2 diabetes requires more than occasional visits to the doctor’s office. Much of the work happens between appointments, making communication and support from others an important part of managing the condition.
But for Black and African American men, experiences of discrimination in healthcare settings may be associated with fewer conversations about their diabetes, even as they remain socially connected, according to research from Texas A&M University.
Black and African American adults are diagnosed with Type 2 diabetes at higher rates than non-Hispanic white adults and face higher rates of serious complications. Dr. Tyler Prochnow, associate professor in the School of Public Health, said understanding what happens after diagnosis is an important part of addressing those disparities.
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In two related studies drawing on a national survey of 1,225 Black and African American men with Type 2 diabetes, Prochnow and his colleagues examined how social networks relate to diabetes outcomes and how experiences of discrimination are associated with communication, mental health and self-care. The studies were published in the Journal of Racial and Ethnic Health Disparities and Social Science & Medicine.
The findings suggest that diabetes-specific conversations are strongly associated with self-care behaviors, but men reporting more healthcare discrimination also reported talking less about their diabetes, despite communicating more frequently with people in their social networks overall.
When discrimination follows patients home
The researchers examined whether discrimination in everyday life and discrimination in healthcare settings were associated with different patterns of communication.
To measure discrimination, Prochnow said the researchers used the Everyday Discrimination Scale, asking questions related to being treated with less respect than others, receiving poorer service or being treated as less intelligent.
“We used an adapted measure for medical settings specifically, asking things like how often you are treated with less respect than other people when you go to a doctor’s office,” he said. “Prior research documents differential treatment, reduced provider empathy and communication barriers as medical discrimination, and our participants’ responses were consistent with that.”
Prochnow said his research showed that everyday discrimination was linked to more conversation of every kind, including diabetes, while healthcare discrimination was associated with more general conversation but less diabetes-focused discussion.
Prochnow said managing Type 2 diabetes is heavily dependent on trust and communication between a patient and their care teams, and negative experiences during medical appointments can cause lasting harm.
“The finding that stuck with me most is that men reporting more healthcare discrimination were talking to their networks more overall, but talking about their diabetes less,” he said. “They are still connected, still reaching out. What goes quiet is the health conversation specifically. That looks like a specific protective response, shutting down the topic that made you vulnerable while keeping the relationships intact. And it happens to shut down the exact conversation most strongly tied to good self-care in our data.”
Why the quality of support matters
The findings also suggest that more communication is not always better.
While the standard course of action for healthcare providers is to increase contact with patients and encourage support group meetings, Prochnow said his research shows frequent communication, including more frequent diabetes talk, was associated with worse mental health for patients. Meanwhile, men whose social networks had a high proportion of people they considered genuinely supportive of their diabetes reported better mental health and self-care, Prochnow said.
“The practical message is volume is not always the lever. A conversation about diabetes can be a source of pressure, nagging, fear or being put on trial for everything you are doing wrong,” he said. “Support for discrimination-related distress is hard to provide if you have not lived it, and it has to work with, not against, the values these men hold around strength, independence and providing for their families.”
For healthcare providers, Prochnow said the findings point to the importance of culturally responsive support and communication rather than frequent contact.
“The burden should not be on these men to fix a system that is failing them, but the people they talk to about their diabetes matter enormously, not just how many,” he said. “Even one person who is genuinely in it with a patient appears to be worth more than a large circle of people.”
Other research collaborators include Ledric Sherman and Meg Patterson in the Texas A&M School of Public Health and Matthew Lee Smith in the Indiana University School of Public Health.
