Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems
Received 18 February 2007; received in revised form 3 September 2007; accepted 16 September 2007.
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-management 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.
aDepartment of Medicine, Division of General Internal Medicine, University of California, San Francisco, United States
bHealth Services Research and Development, VA Ann Arbor Healthcare System, United States
cDepartment of Internal Medicine, University of Michigan, Ann Arbor, United States
dMichigan Diabetes Research and Training Center, Ann Arbor, United States
eDepartment of Medicine, University of Washington, Seattle, United States
fCook County Bureau of Health Services, Chicago, United States
gEarl K. Long Medical Center, Louisiana State University, New Orleans, United States
hCambridge Health Alliance, Cambridge, United States
iGeorge Washington University, Washington, United States
jUniversity of California San Francisco, Center for Vulnerable Populations, San Francisco General Hospital, United States
Corresponding author at: Division of General Internal Medicine, UCSF Box 1732, San Francisco, CA 94143-1732, United States. Tel.: +1 415 476 1108; fax: +1 415 814 5770.
ABSTRACT