Defining multilevel interventions to improve type 2 diabetes management for Black patients in North Florida: a community-based systems dynamics approach.

Abstract

Background: Racism is a driver of community health disparities, and there is a dearth of evidence-based multilevel antiracism interventions developed in partnership with community constituents. Community-engaged systems science defines intervention points within complex systems and was utilized for early-phase multilevel intervention development within the ORBIT translational model to improve type 2 diabetes (T2DM) management among Black patients in the South.

Methods: Group model-building sessions were conducted with five primary care physicians, thirteen nurses, six support staff, and nine Black patients with T2DM in North Florida and analyzed with qualitative systems science methods. Facilitation scripts were developed with a core modeling team consisting of investigators and community partners.

Results: Resulting systems maps suggested leverage points for interventions, including strategies to increase trust and support, such as increasing appointment length and quality and deepening the health care system's understanding of race and culture as strengths instead of barriers.

Conclusion: Formal care coordination pathways to reduce structural racism and address social determinants of health without stigma are needed, with multilevel interventions to address provider support and improve trust. This study demonstrates how to use community-engaged systems science within a translational behavioral medicine framework to define multilevel interventions to reduce health disparities in other systems.