The Care Experience for American Indian/Alaska Natives with Type 2 Diabetes Within a Commercial Context: A Qualitative Analysis.

Abstract

American Indian and Alaska Native (AI/AN) adults experience type 2 diabetes (T2DM) at twice the rate of non-Hispanic White adults in the United States. Although AI/ANs receive T2DM care across various settings, most research in this group has been conducted within the Indian Health Service. We sought to understand the experience of AI/AN adults with T2DM accessing a commercial healthcare system for diabetes care. The qualitative portion of a multi-method study on diabetes care and medication adherence. AI/AN adults, aged 18-65, with T2DM and a recorded A1C level in the last year. This study was conducted in a large non-profit commercial healthcare system spanning five states in the Western United States. Participants completed electronic surveys and were invited to participate in qualitative interviews. Semi-structured interviews were conducted with 15 participants. Interview transcripts were coded and analyzed using a combination inductive-deductive approach to thematic analysis. Four main themes emerged: difficulty navigating healthcare system bureaucracy, digital devices facilitating access to care, positive relationships with healthcare providers, and a mixed desire for cultural care accommodation. Participants identified opportunities to improve diabetes care, including offering diabetes education both at diagnosis and intermittent refresher education, ensuring care aligns with up-to-date guidelines, and improving access to necessary resources. While participants were satisfied with their diabetes care, difficulty navigating healthcare system bureaucracy impeded participants' ability to complete self-care tasks. Furthermore, our findings indicate more work is needed to understand the role of culturally tailored care in this setting.