Self-Efficacy as a Catalyst for Change

Perceptions of health disparities among African Americans.

Posted Jul 22, 2018

Comorbidity among African Americans in the United States with major depressive disorder and diabetes accounts for approximately 21 million individuals being diagnosed with diabetes and over eight million individuals being undiagnosed with diabetes whilst major depression only accounts for 7.6% of Americans aged 12 and over (Centers for Disease Control, 2014). Amazingly, according to Agyemang, Mezuk, Perrin and Rybarczyk (2014), African Americans with major depression report more chronic symptoms and are less likely to receive adequate healthcare compared to non-Hispanic whites. A large proportion of the evidence suggests that African Americans are at greater risk for being underdiagnosed and undertreated. Ironically, the thought would be that the more patient visits that are made to their primary care physician for one illness, the more likely they would be to have treatment for the second illness.

However, social activists who envisioned a better America in terms of equality and educational freedom, have inscripted upon the fabric of how research is conducted, how the results are used, and most importantly, the perception of ethical decision making in the science of social and medical behavior. The legacies of individuals such as Kenneth and Mamie Clark, in 1939 with their famous doll studies, undoubtedly embodied the marriage between social scientific research and the implications for practice like never before. The zeitgeist of the 1940’s and 50’s imposed social, economic and ethnic lines of inequalities upon society that created such issues as educational segregation, medical segregation and presently to health disparities in underprivileged and underserved minorities (Ancheta, 2006). Many researchers have spent most of their professional career attempting to erase those inequalities—some, with much success, and others, with a need for new professionals to create and define ways to unite the research and the practice together to bring innovation and technology into those underprivileged communities.

This health disparity in African Americans seem to suggest the opposite. The main reasons for some of the disparities point to lower initiation rates for the diagnosis of major depression and the physician’s likelihood to under detect symptoms (Agyemang, Mezuk, Perrin and Rybarczyk ,2014). The health disparity among African Americans has been well noted (Spanakis & Golden, 2013;Groh & Moran, 2016; Meanear, Duhoux, Roberge & Fournier, 2014). In contrast to the similar findings that comorbidity with depression and medical conditions lead to lower treatment of the psychological symptoms whereas Meaner, Duhooux, Roberge and Fournier (2014) found that individuals with medical comorbidity alone received higher levels of treatment compared to those with psychiatric comorbidity alone. Bell, Smith, Arcury, Snively, Stafford and Quandt (2005) collected data from the study ELDER (Evaluating Long-Term Diabetes Self-Management Among Elder Rural Adults) comparing elderly participants of the following races: African-American, Native American, and Caucasian men and women in rural areas, specifically located in North Carolina. Their analysis criterion was based on the Center for Epidemiologic Study of Depression scale. The results revealed a higher risk of depressive symptoms regardless of ethnicity. The findings concurred that there is limited research knowledge on the co-morbidity of Depression and Diabetes in this population

One answer is to increase self-efficacy about healthy lifestyle choices to help individuals to believe that they can solve problems, become sociable, and self-regulate behaviors that produce functional outcomes. This leads to motivation in the process which influences observational learners to attend to, retain and to produce modeled behaviors that are important within the individuals’ social context. If individuals can form anticipated expectations about anticipated outcomes, a healthy lifestyle could soon ensue. According to Kirchhoff, Elliott, Schlichting and Chin (2008) the main facilitators to maintaining a healthy lifestyle are (1) being perceived as a positive role model (2) establishing good rapport and (3) setting and achieving goals. These facilitators link directly to the overall perception that environment, behavior and personal factors which are all capable of producing changes in the individuals’ belief system and ultimately behavioral changes. Groh and Moran (2016) found that increasing self-efficacy and patient empowerment may be a solution for positive health maintenance. Health providers can use technological interventions to influence behavioral change such as follow through with treatment plans and health plans. Secondly, providers can reinforce the goals of the treatment and health plans with social role modeling, environmental role modeling and health tracking through telephone support by trained professionals and lastly, providers that provide positive reinforcement from family, other medical or social support providers and peers can lead to enhanced self-management.

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Agyemang, A.A., Mezuk, B., Perrin, P.&  Rybarczyk, B. (2014). Quality of depression treatment in Black  Americans with major depression and comorbid medical illness. General Hospital Psychiatry, 36(4), 431-436.

Ancheta, A.N. (2006). Scientific evidence and equal protection of the law. New Jersey: Rutgers University Press.

DePoy, L. & Gitlin, L.N. (2016). Experimental type designs In Introduction to research design: Understanding and applying multiple designs. St. Louis: Elsevier, pp. 134-577.

Groh, C. J. & Moran, K.J. (2016). Depression and diabetes in a primarily African American female population. Issues in Mental Health Nursing, 37(2), 106-112.

Katon, W. J. (2008). The comorbidity of diabetes mellitus and depression. The American Journal of Medicine, 121(11), S2, S8-S15. doi:

Kirchhoff, A. C., M.P.H., Elliott, L., M.D., Schlichting, J. A., M.S., & Chin, Marshall H,M.D., M.P.H. (2008). Strategies for physical activity maintenance in African American women. American Journal of Health Behavior, 32(5), 517-24.

Menear, M., Duhoux, A., Roberge, P. & Fournier, L. (2014). Primary care practice characteristics associated with the quality of care received by patients with depression and comorbid chronic conditions. General Hospital Psychiatry, 36(3), 302-309.

Schunk, D.H. (2000). Learning theories: An educational perspective. (3rd ed.). Upper Saddle River, NJ: Prentice Hall

Spanakis, E.K. & Golden, S.H. (2013). Race/ethnic difference in diabetes and diabetic complications. Current Diabetes Report, 13(6), 814-823. doi: 10.1007/s11892-013-0421-9.

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