Perceived racial discrimination in health care, completion of standard diabetes services, and diabetes control among a sample of American Indian women

Diabetes Educ. Nov-Dec 2014;40(6):747-55. doi: 10.1177/0145721714551422. Epub 2014 Sep 23.


Purpose: The purpose of this study is to examine perceived experiences of racial discrimination (perceived discrimination) in health care and its associations with completing standards of care for diabetes management and diabetes control.

Methods: This cross-sectional study included 200 adult American Indian (AI) women with type 2 diabetes from 4 health care facilities located on tribal reservations in the Pacific Northwest. Participants completed a survey, and medical records were abstracted. Logistic regression was completed to assess associations.

Results: Sixty-seven percent of AI women reported discrimination during their lifetime of health care. After adjusting for patient characteristics, perceived discrimination was significantly associated with lower rates of dental exam; checks for blood pressure, creatinine, and total cholesterol; and pneumococcal vaccination. The association between perceived discrimination and total number of diabetes services completed was not statistically significant. Perceived discrimination was associated with having A1C values above target levels for diabetes control in unadjusted and adjusted models, but no association was observed for blood pressure or total cholesterol.

Conclusions: In our sample of AI women with diabetes, two-thirds reported experiencing racial discrimination in their health care experience. Those reporting perceived discrimination completed fewer diabetes services and therefore may be at increased risk for comorbidities of diabetes. This finding supports the continued need for culturally responsive health care and programs of diabetes education to recognize perceived discrimination and its potential to impact success in self-management and services utilization.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data*
  • Health Status Disparities
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Indians, North American* / psychology
  • Middle Aged
  • Northwestern United States / epidemiology
  • Perception
  • Prevalence
  • Racism / psychology
  • Racism / statistics & numerical data*
  • Self Care / psychology
  • Self Care / statistics & numerical data*
  • Social Class
  • Surveys and Questionnaires
  • Women's Health