Applying the theoretical domains framework to identify determinants to mental healthcare use among older African Americans with type 2 diabetes: a qualitative study

• Published in: BMJ open 2024-10, Vol.14 (10), p.e073689
• Main Authors: Hawkins, Jaclynn, Sengupta, Srijani, Kloss, Katherine A, Schwenzer, Claudia, Smith, Fonda N, Jones, Lenette M, Mitchell, Jamie, Nwankwo, Robin, Piatt, Gretchen A
• Format: Article
• Language: English
• Subjects: African Americans; Aged; Black or African American - psychology; Comorbidity; depression & mood disorders; Depression - ethnology; Diabetes; diabetes & endocrinology; Diabetes and Endocrinology; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Female; Females; Health care expenditures; health equity; Health Services Accessibility; Humans; Intervention; Interviews; Interviews as Topic; Male; Mental depression; mental health; Mental health care; Mental Health Services; Middle Aged; Minority & ethnic groups; Original Research; Patient Acceptance of Health Care - ethnology; Patient Acceptance of Health Care - psychology; Qualitative Research; Social Stigma; Women
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-073689

ObjectivesThere is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living with comorbid depression. This study aims to identify barriers and facilitators to mental healthcare utilisation among this population, guided by the theoretical domains framework (TDF).DesignThis qualitative study involved 30 interviews with older African American adults diagnosed with T2D. The interview questions were aligned with TDF domains to capture participant perspectives on barriers and facilitators to mental healthcare use.SettingInterviews were conducted via telephone by a licensed clinician trained in social work. Each session lasted 60–90 min and was transcribed and analysed.ParticipantsThe study included 30 African American adults (15 males and 15 females), aged 60 and above, living in an urban area in the Midwest.Primary and secondary outcomesThe primary outcome was the identification of themes from participant responses, analysed using thematic content techniques and categorised into TDF constructs. Demographic data served as the secondary outcome.ResultsNine key themes were identified, categorised under major TDF domains and constructs. Significant barriers included (1) systemic racism (‘knowledge’), (2) normalisation of depressive symptoms (‘beliefs about consequences’), (3) perceived stigma (‘beliefs about consequences’) and 4) costs of medications and healthcare (‘environmental context and resources’). Facilitators to seeking mental healthcare included (1) empowerment (‘beliefs about capabilities’), (2) perceived benefits of mental health exams (‘beliefs about consequences’), (3) positive provider experiences (‘reinforcement’), (4) recognition of depressive symptoms as a motivator (‘goals’) and (5) support networks (‘social influences’).Conclusion and implicationsKey findings highlight that fostering positive patient–provider relationships and enhancing self-recognition of depressive symptoms can significantly encourage mental healthcare utilisation among older African Americans with T2D. These findings suggest that future interventions should focus on strengthening these relationships and improving self-awareness to better mental health outcomes.