Achieving Equal Opportunity and Justice in Community Health Care Services: Applying a Social Determinants Approach and Evidence-Based Practices in Rural Mississippi

Background and Purpose:Significant health disparities persist in rural communities in the United States and epidemiologic documentation shows African Americans (AA) disproportionately bear the illness burden of type 2 diabetes (T2D) especially in the rural Delta areas of the Deep South, specifically Mississippi. Most studies have framed adherence to T2D self-management from a disease/medical perspective, often ahistorical and devoid of context. Non-adherence is primarily cast as a personal failure potentially leading to severe consequences.

This qualitative study helped address this knowledge gap and aimed to 1) better understand T2D-diagnosed African Americans’ own perceptions of what may either hinder or promote self-management in their sociocultural environments and 2) develop a framework to enhance opportunities and provide equitable and just health care services that promote better policy and practice implications within the community.

 Methods: The narrative approach used in this study promoted trust and encouraged participants to voice their experiences. Approval from the University Institutional Review Board was given and a thematic, open-ended, semi-structured guide was developed from literature reviews and evidence-based studies for participant interviews. Each interview, conducted by the principal investigator, was 45-60 minutes long. Recruitment methods used included posting flyers and community outreach strategies such as sharing news about the study during informal community gatherings. Thirty-one AA adults—15 males and 16 females—participated in this study. Sixty percent of the female interviewees and 56% of the male interviewees were aged 45 to 64 years, while more than 30% of both genders were aged 65 years or older. Participant narratives were gathered and analyzed using grounded theory.

Findings:   The participants revealed that, even after diagnosis, they were not aware of T2D’s chronic nature because they were asymptomatic or had nonspecific symptoms. They interpreted medically prescribed dietary and physical exercise guidelines as impractical and culturally irrelevant to them. Their beliefs on the use of medicines were described as: (a) Needed when one does not feel good, (b) One takes medicine to relieve symptoms and (c) The family history that doctors take and explore is uncomfortable and unnecessary. To stay healthy, often herbal medicines are preferred and death is simply “when it is time to go.” Listening to the participants’ language and narratives allowed the researchers to capture their beliefs and values regarding the emotional dimensions of culturally embedded behavioral practices.

Conclusion and Implications:   Health needs to be valued not as the absence of disease but as a resource that enables individuals and communities to enhance quality of life. A framework using a social determinants approach integrates T2D diagnosed African American’s real life experiences with the sociocultural contexts in which they live and make their health behavior choices present. The use of evidence-based information about belief in personal resiliency and celebrating strengths from historical perspectives are powerful tools to take ownership and engage in self-management. Engaging African Americans diagnosed with T2D in community-based programs will be a promising start.