New research by Vanderbilt nephrologists highlights potential barriers that may prevent black Americans from being screened for kidney disease.
The findings, published March 15 in the Clinical Journal of the American Society of Nephrology, may help guide efforts to address important kidney-related disparities in the United States, where the incidence of kidney failure is three times higher in black Americans than in whites, and the prevalence of chronic kidney disease (CKD) continues to rise among black Americans while it has stabilized in other racial groups.
In the study of 32 black Americans who participated in focus group sessions, two major categories of barriers to kidney disease screening were apparent: participant factors including limited kidney disease knowledge, spiritual/religious beliefs, and culture of the individual; and logistical factors including lack of convenience and incentives, and poor advertisement.
“In particular, trust and effective communication appear to be novel influential themes for achieving optimal participation of black Americans in kidney disease screening events,” said the study’s first author, Ebele Umeukeje, MD, MPH, assistant professor of Medicine in the Division of Nephrology and Hypertension at Vanderbilt.
“Therefore, culturally sensitive education and stakeholder engagement are likely effective strategies to improve communication, build trust, minimize fear, maximize participation in kidney disease screening events, and ultimately improve outcomes in black Americans at risk of kidney disease.”
Umeukeje said that the low trust among black Americans extended beyond mistrust of research and healthcare practices to include mistrust of certain aspects of community- based screening practices.
“For instance, there was mistrust of urine collection because of a concern that it may be used for drug screening instead of detection of protein in urine, which is a marker of kidney disease,” she said. “Additionally, spirituality among black Americans and the notion that self-care is really God’s responsibility was also found to discourage some people from embracing kidney disease screening practices.”
Stigma associated with a kidney disease diagnosis and the explicit fear of being diagnosed with a condition that could lead to dialysis was a significant concern. Interestingly, there was concern from men about being labeled with a diagnosis that would force them to assume a ‘sick role,’ which they felt would challenge their manhood, or the need to take medications that might decrease their libido. Many people admitted that incentives such as gift items, free food, and entertainment would encourage participation in kidney disease screening programs.
Kerri Cavanaugh, MD, MHS, associate professor of Medicine in the Division of Nephrology and Hypertension and co-director of the Vanderbilt Center for Effective Health Communication, is the study’s senior author.
Co-authors include Marcus Wild, Saugar Maripuri, MD, MPH, Teresa Davidson, Margaret Rutherford, Khaled Abdel-Kader, MD, MS, Julia Lewis MD, and Consuelo Wilkins MD, MSCI.