Barriers and facilitators to shared decision-making among African-Americans with diabetes

J Gen Intern Med. 2009 Oct;24(10):1135-9. doi: 10.1007/s11606-009-1047-0. Epub 2009 Jul 4.


Introduction: Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans.

Objective: We explored the barriers and facilitators to SDM among African-Americans with diabetes.

Methods: Qualitative research design with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted using an iterative process.

Participants: We utilized a purposeful sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center.

Results: Patients identified multiple SDM barriers/facilitators, including the patient/provider power imbalance that was perceived to be exacerbated by race. Patient-related factors included health literacy, fear/denial, family experiences and self-efficacy. Reported physician-related barriers/facilitators include patient education, validating patient experiences, medical knowledge, accessibility and availability, and interpersonal skills.

Discussion: Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Black or African American / ethnology*
  • Black or African American / psychology
  • Decision Making*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / psychology
  • Diabetes Mellitus / therapy
  • Female
  • Humans
  • Interviews as Topic / methods
  • Male
  • Middle Aged
  • Patient Education as Topic / methods
  • Patient Participation* / methods
  • Patient Participation* / psychology
  • Physician-Patient Relations*
  • Young Adult