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Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes



Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system.

Research Design and Methods

We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis.


Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans.


To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.

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This study was funded by grant K23DK110316 from the National Institute of Diabetes and Digestive and Kidney Disease.

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Authors and Affiliations



D.C.L, M.R., and C.Q. researched data, contributed to discussion, and wrote, reviewed, and edited the manuscript. M.O. and Y.A. researched data and reviewed and edited the manuscript. S.P.W. contributed to the discussion and reviewed and edited the manuscript. E.M.N. and J.E.R. reviewed and edited the manuscript. All authors approved the final version of the manuscript. D.C.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to David C. Lee.

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The authors declare no competing interests.

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Appendix 1

See Table 2.

Table 2 Interview questions

Appendix 2

See Table 3.

Table 3 Patient characteristics

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Rony, M., Quintero-Arias, C., Osorio, M. et al. Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes. J. Racial and Ethnic Health Disparities (2022).

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  • Diabetes
  • Preventive screening
  • Medical mistrust
  • Minority health