525 - Parent’s Perspectives of Provider and Healthcare System Drivers of Racial Disparities in the Use of Technology in Children with Type 1 Diabetes
Friday, April 22, 2022
6:15 PM – 8:45 PM US MT
Poster Number: 525 Publication Number: 525.107
Jennifer F. Morone, Yale University, New Haven, CT, United States; Carol J. Howe, Texas Christian University, Fort Worth, TX, United States; Claire Bocage, University of Pennsylvania School of Nursinf, Philadelphia, PA, United States; Steven M. Willi, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Colin P. Hawkes, Cork University Hospital, Cork, Cork, Ireland; Terri H. Lipman, University of Pennsylvania School of Nursing, Phila, PA, United States
NCSP Post-Doctoral Fellow Yale University New Haven, Connecticut, United States
Background: Intensive diabetes management and improved glycemic control decrease the risk of the long-term complications of type 1 diabetes (T1D). Marked racial disparities, regardless of socioeconomic status (SES), have been described across all aspects of diabetes treatment and outcomes. Despite significant advancements and uptake of insulin pumps and continuous glucose monitors (CGM) in the management of T1D, racial minority youth are significantly less likely to use diabetes technology. The impact of provider and health system factors on decision making related to diabetes technology use are underexplored in pediatric diabetes.
Objective: The purpose of this prospective, observational, qualitative study was to: 1) identify factors that influence parents’ decision making on the use of pediatric diabetes technology and, 2) examine how these factors differ between Black and White parents.
Design/Methods: A purposive sample of Black and White identifying parents of youth with T1D from an urban pediatric diabetes center was divided into four groups: White Using/Not Using Technology and Black Using/Not Using Technology. Online structured focus groups were conducted. Deductive thematic content analysis was employed.
Results: Twenty-one parents participated across 6 focus groups (12 Black, 9 White-identified). Five emerging themes across health system, clinical encounter and provider-level factors included: timeframe of initial discussion, obtaining technology related education, clinical communication about technology, insurance changes and coverage, and having ready access to technology through clinical studies. Racial differences were noted between Black and White parents with regards to Black parents experiencing provider determined process delays, hurdles, barriers and limitations to accessing technology such as criteria based on time from diagnosis and rules around acceptable glucose control; fewer reports of provider expectations around using technology; negative shared decision-making communication; and unsupportive provider attitudes regarding technology use in suburban versus urban clinic settings.Conclusion(s): Parent level perceptions and experiences of health care systems, providers, and clinical encounters are critical to understanding the decision-making process regarding use of diabetes technology. Racial differences in the parent experience suggests multiple layers of provider driven and healthcare system barriers regarding accessing diabetes technology that may contribute to marked racial disparities in diabetes treatment and outcomes and provides additional evidence of structural racism in healthcare.