Source:MedPageToday.com

Low trust in doctors and the healthcare system, as well as poor communication from clinicians, were some of the barriers to kidney disease screening among black Americans, according to a focus group-based study.

Lack of knowledge about chronic kidney disease (CKD) and its risk factors, as well as the belief that, "God is ultimately in charge of their health," were other barriers identified by Ebele Umeukeje, MD, of Vanderbilt University Medical Center in Nashville, and colleagues.

Strategies to overcome these obstacles should include more culturally sensitive education about CKD, collaboration with community spiritual leaders, and more convenient screening opportunities, the team advised in the Clinical Journal of the American Society of Nephrology.

The incidence of CKD is three times higher in blacks than in whites, and the prevalence of the disease has stabilized among all racial groups in the United States except black Americans, the study authors said.

The current study confirmed results of previous studies, but also identified important new barriers: "We identified that in black Americans, trust and effective communication from physicians about kidney disease were important in achieving optimal participation in community CKD screening," Umeukeje and colleagues wrote. "Our findings emphasize the need for establishing strong collaborative partnerships with community leaders and stakeholders, with the aim of building trust among minority populations."

The study was based on three focus group sessions that included 32 black Americans. Their mean age was 56, and the majority (79%) were female. Most had more than a high school education (82%) and had health insurance (91%). Few self-reported a diagnosis of kidney disease (3%), but most reported having risk factors such as hypertension (70%), diabetes (24%), or a family history of kidney disease (27%).

The focus group discussions, which each lasted about an hour, were led by a clinician researcher trained in moderating group discussions; another researcher took notes. The sessions were also recorded and transcribed verbatim. The transcriptions were analyzed with HyperRESEARCH qualitative data-analysis software.

Key barriers to CKD screening identified by the researchers included the following:

• Lack of education and testing from providers: Participants said that physicians did not routinely discuss health issues that could result from CKD risk factors until they either became symptomatic or had abnormal lab results. In addition, they said physicians didn't provide as much information about CKD as for other diseases such as heart disease and breast cancer

• Low trust: "More specifically, we discovered that participants were distrustful of urine collection during CKD screening, because they suspected that it would be used for purposes other than screening for proteinuria, such as drug testing," the study authors said. Screening programs need to make overt declarations of the purpose and use of any bio specimens to build confidence and not deter participation

• Religious beliefs: "A key belief expressed was that people are absolved of the responsibility of self-care because 'God will take care of them,'" the researchers said. "Consideration for CKD patients' spirituality should be encouraged, because of its direct correlation with health-related quality of life, mental health, and life expectancy." The team recommended collaboration with community spiritual leaders, especially to endorse rationales for screening

• Financial concerns: Participants expressed the fear that they could not afford CKD treatments, especially those who lacked health insurance or had high deductibles

• Fear of side effects; ego and machismo: Participants said that men worried about a potential decrease in libido and sex drive from medications such as anti-hypertensives; in addition, the results showed that men resist being labeled with a diagnosis that would force them to assume a "sick role," which would challenge their manhood

Writing in an accompanying editorial, Keith Norris, MD, and Susanne Nicholas, MD, both of the David Geffen School of Medicine at UCLA, said that the study's small sample size potentially limited its generalizability, even to other groups of black Americans.

Nevertheless, the study provided "a timely and well-balanced set of recommendations capturing key barriers and facilitators to consider in advancing CKD screening," Norris and Nicholas wrote. "Ongoing authentic engagement with respect and partnership can help to attenuate the mistrust and activate African American communities to take a more proactive stand on their health."