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

• Published in: Patient education and counseling 2008-01, Vol.70 (1), p.102-110
• Main Authors: Sarkar, Urmimala, Piette, John D, Gonzales, Ralph, Lessler, Daniel, Chew, Lisa D, Reilly, Brendan, Johnson, Jolene, Brunt, Melanie, Huang, Jennifer, Regenstein, Marsha, Schillinger, Dean
• Format: Article
• Language: English
• Subjects: Communication; Cross-Sectional Studies; Diabetes; Diabetes Mellitus - ethnology; Diabetes Mellitus - therapy; Diabetics; Disparities; Ethnic Groups - statistics & numerical data; Female; Group medical visits; Health education; Health literacy; Hotlines; Humans; Internal Medicine; Internet; Male; Middle Aged; Multivariate Analysis; Nursing; Patient Education as Topic - methods; Patient Satisfaction - ethnology; Poverty; Preferences; Racial/ethnic minority; Self Care; Self-Help Groups; Self-management; Selfmanagement; Service delivery; Social Support; Telephone care; United States
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2007.09.008

Abstract Objective 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 (response rate 47%) recruited from four 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 self-management support acceptance. Results Sixty-nine percent of respondents reported interest in telephone support, 55% in group medical visits, and 42% in Internet. Compared to Non-Hispanic Whites, Spanish-speaking Hispanics were more interested in telephone support (OR 3.45, 95% CI 1.97–6.05) and group medical visits (OR 2.45, 95% CI 1.49–4.02), but less interested in Internet self-management support (OR 0.56, 95% CI 0.33–0.93). African–Americans were more interested than Whites in all three 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. Conclusion Many diabetes patients in safety-net settings report an interest in receiving self-management 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 self-managem