Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems

Abstract

Objectives-We sought to identify interest in different modes of self-management support among diabetes patients cared for in public hospitals, and to assess whether demographic or disease-specific factors were associated with patient preferences. We explored the possible role of a perceived communication need in influencing interest in self-management support.Methods-Telephone survey of a random sample of 796 English and Spanish-speaking diabetes patients (esponse rate 47%) recruited from 4 urban US public hospital systems. In multivariate models, we measured the association of race/ ethnicity, primary language, self-reported health literacy, self-efficacy, and diabetes-related factors on patients' interest in three self-management support strategies (telephone support, group medical visits, and internet -based support). We explored the extent to which patients believed that better communication with providers would improve their diabetes control, and whether this perception altered the relationship between patient factors and selfmanagement support acceptance. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. CI 0.33-0.93). African-Americans were more interested than Whites in all 3 self-management support strategies. Patients with limited self-reported health literacy were more likely to be interested in telephone support than those not reporting literacy deficits. Forty percent reported that their diabetes would be better controlled if they communicated better with their health care provider. This perceived communication benefit was independently associated with interest in self-management support (p<0.001), but its inclusion in models did not alter the strengths of the main associations between patient characteristics and self-management support preferences. NIH Public AccessConclusion-Many diabetes patients in safety-net settings report an interest in receiving selfmanagement support, but preferences for modes of delivery of self-management support vary by race/ethnicity, language proficiency, and self-reported health literacy.Practice Implications-Public health systems should consider offering a range of selfmanagement support services to meet the needs of their diverse patient populations. More broad dissemination and implementation of self-management support may help address the unmet need for better provider communication among diabetes patients in these settings.

Health literacy and quality of care of patients with diabetes: A cross-sectional analysis

“…It is also close to those from several US studies that used the same screening question, in which prevalence of good FHL varied between 39% and 53%, despite the fact that various population and healthcare context were considered [22][23][24].…”

Out-of-office hours nurse-driven acute telephone counselling service in a large diabetes outpatient clinic: A mixed methods evaluation

“…This finding is in concordance with other studies showing a need for support between clinical visits and assistance in meeting selfcare goals [4,10,18,24]. Particularly in critical situations with the risk of admission, it is imperative that the patients are aware of and use any support available, such as ATC [24].…”

Bridging the Digital Divide in Diabetes: Family Support and Implications for Health Literacy

“…Health literacy was assessed with the three-item health literacy screening questionnaire, 17,18 which has been validated against widely used measures of health literacy. [19][20][21] Items ask respondents: (HL Q1) ''How often do you have someone help you read hospital or clinic materials? ''; (HL Q2) ''How confident are you filling out medical forms by yourself?…”

“…In keeping with prior studies, respondents scoring 1-5 (ever having problems) were categorized as having limited health literacy, and those scoring 6 (never having problems) were categorized as having adequate health literacy. 19 Each item was analyzed separately as the developers of these items recommend. 17,18 Numeracy.…”