TOWARD A CULTURALLY-TAILORED SELF-MANAGEMENT CONCEPTUAL FRAMEWORK FOR BLACK ADULTS: A SCOPING REVIEW

Abstract

Chronic disease self-management empowers individuals and their families and eases the financial burden on the healthcare system. Despite this, self-management education programs have been shown to have limited self-efficacy among older Black adults, primarily because these programs have not adequately addressed the importance of the social determinants of health and inequities that impact upstream health outcomes. To address this issue, an extensive scoping review was conducted (4513 articles searched) to broadly review the literature in this area using Arksey and O’Malley’s (2005) framework further advanced by Levac et al. (2010). The scoping review included 51 studies and iteratively explored current evidence illuminating the characteristics, elements and gaps in existing literature in relation to the uptake and success of chronic disease self-management education programs for older Black adults. In this knowledge synthesis, in the form of a scoping review, I identified the types of available evidence, analyzed knowledge gaps and reviewed the methods used to study culturally-tailored chronic disease self-management programs and practices for older Black adults. Additionally, I identified key characteristics, clarified key concepts and definitions through the lens of social determinants and health inequities and the four tenets of Critical Race Theory (CRT). The findings from this review have highlighted key factors that influence the self-management of chronic conditions in older Black adult populations. The analysis of these attributes has culminated in the identification of an adapted socio ecological model that will serve as the conceptual framework for a chronic disease self-management education program for older Black adults living with one or more chronic diseases. This program will be used by health professionals who provide self-management education and day-to-day support for older Black adults (and their families) with chronic conditions such as cardiac disease, hypertension and/or diabetes. The purpose of the culturally-tailored program is to provide healthcare professionals with the instructional strategies required to address embedded structural barriers such as racism, and socioeconomic factors that often exacerbate health inequities experienced by older Black adults. It is important to note that the development of the entire education program is beyond the scope of this research.