Cultural and Social Challenges of Diabetes Self-Management Education Through Physicians' Voices.

Objective: The aim of this study is to understand how the physician-patient relationship is related to referral practices for diabetes self-management education and physicians' perceptions of culturally competent health care delivery at a large health system affiliated with an academic medical center in a Midwestern city.

Methods: Sixteen physicians (6 family medicine, 6 internal medicine, 4 endocrinology) participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded. Data were thematically analyzed using MAXQDA software.

Results: All physicians considered diabetes self-management education a very important part of diabetes treatment, but physician referral patterns to diabetes education varied. Study findings indicated that both high and low referring physicians reported providing care that was responsive to personalized patient needs, including cultural beliefs, attitudes, and behaviors that affect health/health care. Building relationships and rapport with patients led to discussions of understanding barriers to diabetes management.

Conclusion: This study highlights physicians' perceptions of and concerns about referrals to diabetes self-management education and the treatment of type 2 diabetes. Physicians understood the personal, environmental, and health care factors that limit the number of racial/ethnic minorities from participating.

Practical Implications: In addition to diabetes education, physicians suggested that additional resources or programs will help them address socioeconomic factors beyond their control and to understand cultural preferences.