Identifying Barriers and Facilitators to Mental Health Care Utilization, Diabetes Self-Management, and Internet/Computer Accessibility and Acceptability

Background and Purpose: Research demonstrates that people living with type 2 diabetes (T2D) are more likely to experience depressive symptoms than those without a diabetes diagnosis. Yet, most people with diabetes and depression do not actually receive a depression diagnosis and mental health treatment. Despite the fact that T2D management interventions have been developed to meet the needs of African Americans, few have developed programming to meet the needs of those living with comorbid depression. The Theoretical Domains Framework (TDF) is a theoretical framework identifying 14 domains related to behavior change. The TDF provides a lens for identifying cognitive, affective, social, and environmental influences on behaviors, which in turn inform behavior change targets for implementation interventions. Using the TDF to guide data collection and analysis, this paper explores barriers and facilitators to mental health care utilization among African Americans with T2D.

Methods: Thirty in-depth, semi-structured interviews were conducted with older adults who were diagnosed with T2D. The sample self-identified as Black/African American, were 60 and older, female/male and resided in a Midwestern urban city. Interviews elicited participant perceptions of barriers and facilitators to mental health care use. Interviews were transcribed verbatim and analyzed using thematic content analysis techniques. The data were then categorized in accordance with the TDF domains and corresponding constructs.

Results: Nine major domains and their constructs were identified and matched with study themes. The most significant barriers and their corresponding domains included: 1) experiences of systemic racism in the medical and mental healthcare system (‘knowledge’), (2) prolonged depression becoming normalized and internalized, or interfering with judgement and decision-making (‘beliefs and consequences’), 3) intrinsic motivation to seek professional help to alleviate symptoms of depression and stress (‘goals’), and 4) affordability of diabetes medications (‘environmental context and resources’).

Themes for facilitators of mental health care included: 1) feeling empowered to seek mental health care and sense of responsibility to take care of oneself (‘beliefs about capabilities’), 2) mental health exams viewed beneficial and perceived stigma for having a mental illness or seeking treatment (‘beliefs about consequences’), 3) previous positive experience with a mental health care provider (‘reinforcement’), 4) awareness of the presence of depression or stress as a motivator for pursuing mental health care (‘goals’), and 5) seeking mental health care through formal and informal support and diverse activity (‘social influences’).

Conclusion and Implications: The present study aligns with current literature demonstrating that older African American men and women with T2D experience barriers to utilizing mental health treatment. Future studies are recommended to further explore the differences in older African American men and women with T2D to generate tailored interventions and treatment that can address the needs of this population.