Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self‐care?

Abstract

Summary Background Research on self-care for chronic disease has not examined time requirements. TRIAD, a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data 11,927 patient surveys from 2000–01. Methods Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results Proportions of patients spending no extra time on foot care, shopping/cooking and exercise were respectively 37%, 52% and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about three more minutes/day. Discussion Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

Time spent on health related activities associated with chronic illness: a scoping literature review

“…Using surveys and phone interviews, Ettner et al [26] studied the impact of socioeconomic status on time spent on self care for people with diabetes, looking specifically at time spent on foot care, shopping for and cooking special foods, and undertaking recommended exercise. Ettner et al found that those spending "extra time" on HRA as a result of having diabetes spent on average an extra 13.41 minutes daily on foot care, 38.57 minutes on exercise and 42.42 minutes on shopping and cooking.…”

“…In summary, studies included for review suggest that over a 24 hour period patients are likely to spend 86 minutes on HRA [20]; less time if they have had a stroke [21], more time if they have diabetes [18,19,26]. If patients also engage in exercise they spend in the order of 35 minutes each day.…”

Long-term detrimental consequences of the onset of type 1 diabetes on annual earnings—evidence from annual registry data in 1990–2005

“…Earlier studies on the effect of the level of education on diabetes health outcomes have found differences regarding the time spent managing the condition and the degree of adherence to prescribed treatment [47,48]. This paper quantifies the size of the reduction in earnings that may be attributed to diabetes onset.…”

Patient Complexity and Diabetes Quality of Care in Rural Settings

“…15 Self-testing of blood glucose requires time and therefore an economic cost that lower-income patients may not be able to afford, 16 yet a recent study demonstrated that extra time spent on self-care activities was greater in traditionally disadvantaged patients. 17 If patients are vigilant about ambulatory glucose monitoring and note worsening glycemic control, medication intensification may be initiated sooner with better health outcomes long-term. Similarly, faithful adherence to appointments may prompt health care providers to attend to problems sooner, before complications arise.…”