Health care decision making among newly housed African Americans diagnosed with diabetes and depression

purpose:  Empowering patients to manage Type II diabetes and depression that makes sense culturally remains an important, effective approach to improve health outcomes (Gavin & Wright, 2007). Yet, the literature is limited on how to support dually diagnosed persons who are low-income and relearning life management skills. This study fills the gap in knowledge about how to improve health care decisions around self-management for dually diagnosed, formally homeless African Americans.

method: Semi-structured face-to-face interviews were conducted with 42 African American men and women diagnosed with type II diabetes and depression receiving services from a Northern California Bay Area city community clinic.  All interviews lasted 1 – 1.5 hours, were audio-taped, and transcribed verbatim. Transcriptions were analyzed using ATLAS.ti (version 7.0).

results: Participants expressed a need for physical health and mental health treatment professionals to agree on a single treatment message that respected their abilities to self-manage. Maintaining a positive self-image through a religious lens, providing electronic resources with images of persons in similar circumstances, instituting culturally informed support groups focused on dietary choices for the dually diagnosed with poor oral health and minimal budgets represented other emerging themes.

conclusions: The study findings call attention to establishing policies that enhance professional communication prior to treatment planning, the role of spirituality in supporting self-management practices, and the recognition of oral health needs. In order to support health care decision-making for the dually diagnosed, future research might focus on examining the complex needs of dually diagnosed low-income adults trying to follow healthy habits.