Barry W. Rovner|Robin J. Casten
Discordant health beliefs and telehealth use in African Americans with diabetes
Thomas Jefferson University|Thomas Jefferson University
four trends transforming healthcare united statesaging population rapid growth africanamerican population rising rates diabetes accelerating use telehealth studies predominately white populations suggest telehealth use ie online access physicians health records improves glycemic control1 african americans however worse glycemic control lower telehealth use whites2 3 racial differences social determinants health diabetes knowledge health computer literacy account disparities4 discordant health beliefs ie patient health beliefs diverge physicians may also contribute5 6 study explored relationship discordant health beliefs telehealth use african americans diabetes crosssectional study baseline data randomized controlled trial rct tested efficacy behavioral intervention reduce return emergency department visits african americans diabetes primary care physicians thomas jefferson university hospital n 94 irb approval obtained participants provided informed consent baseline raceconcordant community health workers administered standardized assessment included demographic data pointofcare hemoglobin a1c testing diabetes selfcare inventoryrevised dscir beliefs medicines questionnaire bmq7 8 dscir yields continuous measure selfreported adherence diabetes selfcare behaviors eg exercise diet maximal attainable score 100 indicates best adherence7 bmq assesses 18 beliefs medications eg harmful addictive overused considered discordant8 discordant health beliefs agreed strongly agreed considered present telehealth use determined electronic medical record statistical tests included oneway analysis variance anova continuous data crosstabulations generating odds ratios categorical variables participants following characteristics mean age 670 75 years 83 women mean years education 129 21 mean hba1c 82 19 figure 1 shows participants telehealth use n 73 686 tended higher rates discordant health beliefs participants telehealth use n 21 314 figure also shows odds ratios belief relation likelihood using telehealth use example participants stated medications worry 032 times confidence interval 086 119 likely use telehealth participants hold belief overall 79 participants held one six discordant health beliefs participants two beliefs n 49 523 compared participant fewer beliefs n 45 477 worse diabetes selfcare ie lower dscir scores 470 sd 149 vs 555 169 respectively f 669 df 193 p 0011 tended higher hba1c levels 84 19 vs 79 19 respectively f 131 df 193 p 023 exploratory study suggests discordant health beliefs common african americans diabetes associated low telehealth use worse diabetes selfcare glycemic control small sample underpowered analyses uncertain generalizability limit findings yet findings align previous studies reporting low telehealth use minority populations4 study adds literature suggesting discordant health beliefs may contribute racial disparity whether concordant ie patient physician health beliefs align discordant ie patient physician health beliefs diverge health beliefs strongly held reason interventions respect patient beliefs nevertheless promoting positive attitudes diabetes treatment potential improve ones health may mitigate effects discordant health beliefs meantime racial disparities telehealth use glycemic control remain study despite limitations may advance efforts ensure african americans gain benefits highquality medical care otherwise available everyone achieving goal reduce racial disparities characterize healthcare united states authors conflicts interest disclose concept design authors acquisition analysis interpretation data authors drafting manuscript barry w rovner robin j casten statistical analysis robin j casten obtained funding barry w rovner rc pennsylvania department health grantaward number sap 4100077081 randomized controlled trial clinicaltrialsgov nct03393338 supported grant pennsylvania department health sap 4100077081 sponsors played role design methods subject recruitment data collections analysis preparation paper