Comparing Patient Perspectives on Diabetes Management to the Deficit-Based Literature in an Ethnic Minority Population: A Mixed-Methods Study

Kathleen Abu-Saad (), Nihaya Daoud, Giora Kaplan, Arnona Ziv, Arnon D. Cohen, Liraz Olmer, Daphna Pollack and Ofra Kalter-Leibovici
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Kathleen Abu-Saad: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
Nihaya Daoud: Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84015, Israel
Giora Kaplan: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
Arnona Ziv: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
Arnon D. Cohen: Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84015, Israel
Liraz Olmer: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
Daphna Pollack: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel
Ofra Kalter-Leibovici: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 52621, Israel

IJERPH, 2022, vol. 19, issue 22, 1-17

Abstract: Marginalized racial/ethnic minorities have disproportionately high rates of type 2 diabetes prevalence, complications and mortality. Researchers and policymakers have typically addressed these disparities using a deficit-based discourse focused on individual/cultural deficiencies or failure. A mixed-methods study was used to compare the deficit discourse to the perspectives of adults with diabetes in the Arab minority in Israel, using data from 10 focus groups (5 men’s, 5 women’s) and 296 quantitative in-person surveys. Both qualitative and quantitative data were triangulated. In addition, multivariable regression models tested associations between diabetes management perspectives and participant characteristics. Contrary to the deficit-based characterizations of patients as fatalistic and unknowledgeable, participants viewed diabetes as a chronic disease with serious complications. They expressed more support for patient responsibility in diabetes management than for passive fatalism, and were less fatalistic as educational level and adequacy of diabetes self-care training increased. The impact of social/environmental barriers and changing cultural norms on lifestyle behaviors was highlighted. Over 95% used prescription medications for diabetes management, although 35% reported economic barriers. The deficit discourse is not well-aligned with Arab patients’ evolving perceptions and needs, and has deflected attention from the socioeconomic/structural determinants of health, and the healthcare system’s responsibility to provide effective, culturally-relevant diabetes services.

Keywords: deficit discourse; racial/ethnic minority; diabetes; patient perspectives; mixed-methods; Arabs; Israel (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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