Healthcare discrimination, healthcare avoidance, and self-rated health in a sample of American Indians with type 2 diabetes.

Indigenous Peoples experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the U.S. Though the management of type 2 diabetes requires regular healthcare visits, North American Indigenous individuals with diabetes do not always utilize the healthcare available to them, and this lack of utilization may lead to poor health outcomes over time. Drawing on literature showing that North American Indigenous patients experience discrimination in healthcare and that experiencing discrimination in healthcare is associated with healthcare avoidance and/or delay, the current study conceptualized unmet healthcare utilization as healthcare avoidance and used path analysis with longitudinal data (four points of data collection) to examine the relationships between healthcare discrimination, healthcare avoidance, and self-rated health in a sample of 192 Indigenous adults with type 2 diabetes from the northern Midwest U.S. We found that healthcare avoidance was negatively associated with baseline self-rated health, and that healthcare avoidance partially explained the negative effect of lifetime healthcare discrimination on self-rated health at the final follow-up of the study. These results show that healthcare avoidance statistically mediates the relationship between healthcare discrimination and self-rated health and suggest that healthcare avoidance is an important mechanism linking healthcare discrimination to worse self-rated health over time. Ultimately, we argue that creating more inclusive and less microaggressive healthcare spaces is important for individual health outcomes and macro-level health inequities. Continued efforts to understand instances of and to diminish healthcare mistreatment of Indigenous Peoples are recommended.