Photovoice As an Integrated Social Determinants of Health (SDOH) Intervention for Diabetes Providers

Background and Purpose:

Diabetes is the 7th leading cause of death in the US and disproportionately burdens Black women. Social Determinants of Health (SDOH), particularly structural racism, drive diabetes health disparities and require creative, multi sector and anti-racist research approaches. Collaborative research capitalizing on Black women’s strengths, providing diabetes providers with tools to explore how SDOH impacts diabetes health disparities are needed. The purpose of this two-phase community engaged qualitative research study exploring the stories of Black women with type-2 diabetes (DM2) is to inform and improve diabetes care and in so doing eliminate disparities. The researcher examined four research questions: 1) How do Black women residing in Boston experience DM2? 2) How do Black women manage DM2 self-care and cope with DM2 challenges? 3) What do Black women think diabetes providers, familial and social network members need to know about their diabetes experiences? and 4) What do participants recommend to enhance provider education?

Methods:

This study was conducted in Boston, employing photovoice and interview methods using a non-probability sampling strategy including purposive and snowball sampling. Data collection included three photovoice group sessions with 11 Black women and individual and focus group interviews with 17 interdisciplinary diabetes providers. The photovoice participants’ analysis was deliberately withheld to facilitate providers sharing their subjective reactions and to minimize provider bias. The researcher adopted a critical and inductive approach to thematic analysis to analyze provider responses and attend to issues of power, and intersections of race, gender and systems of oppression. The researcher developed a codebook and conducted all analysis in Nvivo using Braun & Clarke’s five stage approach.

Results:

Five central themes emerged analyzing provider responses: a)Foundation for Living: understanding the larger social context, strengths and the role of faith in the lives of Black women; b) Diabetes Impacts Families: importance of family support and burdens imposed on families impacted by DM2; c) The Meaning of the Needle: fears and myths connected with injectable insulin; d) Food Choices and Behaviors: diet complexity, cultural norms, beliefs and food insecurity; e) Exercise as a Mandate: barriers and complex messaging around physical activity. Most white providers focused on medical management, suffering and complications associated with diabetes care. In contrast, providers of color emphasized collaborative relationships with Black women with DM2, embraced shared power and celebrated patients’ strengths and accomplishments.

Conclusions and Implications:

This study provides valuable insights by highlighting racial differences in how diabetes providers conceptualize the experiences of Black women with DM2. Photovoice participants wanted to be seen holistically and valued collaborative relationships with their providers. These findings can help providers address their own implicit bias and expand their understanding of SDOH barriers in diabetes care. This study expands existing literature and highlights the benefits of health social workers using community engaged photovoice findings as an intervention tool with diabetes providers. Finally, these insights have implications for improving interdisciplinary teaching models involving social workers as well as patient-provider collaboration in diabetes care.