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APHA Scientific Session and Event Listing

Recorded presentation

Urmimala Sarkar, MD, MPH¹, Daniel Lessler, MD, MHA², Brendan Reilly, MD³, Marsha Regenstein, MD⁴, John D. Piette, PhD⁵, Jennifer C. Huang, MS⁴, Lisa Chew, MD, MPH², Jolene K. Johnson, MD⁶, Melanie J. Brunt, MD⁷, Ralph Gonzales, MD¹, and Dean Schillinger, MD¹. (1) Department of Medicine, University of California, San Francisco, Box 1211, San Francisco, CA 94143-1211, 415-939-1907, urmimalasarkar@yahoo.com, (2) Ambulatory Care, Harborview Medical Center/University of Washington, 325 9th Ave, Box 359704, Seattle, WA 98104, (3) Department of Medicine, Cook County Hospital, 1900 W Polk St. 15th Floor, Room 2207, Chicago, IL 60612, (4) School of Public Health and Health Services, George Washington University, 2021 K Street NW, Suite 800, Washington, DC 20006, (5) Department of Internal Medicine, University of Michigan, Ann Arbor, North Ingalls Building, 300 North Ingalls, Rm 7E10, Ann Arbor, MI 48109-0429, (6) Earl K. Long Medical Center, Louisiana State University, 5825 Airline Highway, Baton Rouge, LA 70805-2498, (7) Cambridge Health Alliance, Harvard University, 1493 Cambridge Street, Cambridge, MA 02139

BACKGROUND. Effective diabetes self-management support can improve clinical outcomes. Because diabetes disproportionately affects low-income, limited-literacy and ethnic/racial minority populations, we assessed patient interest in 3 different approaches to support diabetes self-management in a vulnerable population. METHODS. The Consortium for Quality Improvement in Safety Net Hospitals and Health Systems conducted a telephone survey of English and Spanish-speaking adults with diabetes at 4 urban US public health systems. We assessed interest in receiving self-management support via telephone, group medical visits, or internet. We also measured age, race/ethnicity, language, education, health literacy, diabetes duration, health status, and prior diabetes education. RESULTS. Response rate= 47%. Of 802 participants, the mean age was 58, 23% had <8th grade education, 40% black, 59% white, 33% Hispanic. Mean diabetes duration was 11.3 years; 49% reported their health as poor or fair. 38% had inadequate health literacy; 40% had prior diabetes education. 69% reported interest in telephone self-management, 55% in group visits, and 42% in internet. In multivariate regression, Spanish speakers (AOR=3.8) and those with inadequate health literacy (AOR=1.3) were more interested in telephone self- management support. Similarly, Spanish speakers (AOR=2.6), diabetes education attendees (AOR=1.5), and those with poor or fair health (AOR=1.5), reported more interest in group visits. English speakers (OR=1.6) and those with higher educational attainment (OR=2.1) preferred internet management. CONCLUSIONS. Preferences for diabetes self-management vary by health status, language, race/ ethnicity, and health literacy. Public health care systems can use these findings to develop appropriately tailored, self-management support programs for vulnerable populations.

Learning Objectives: At the conclusion of this session, the participant (learner) will be able to

• Recognize the relative acceptability of telephone-based, group visit, and internet interventions for diabetes self-management among underserved adults.
• Identify important differences in preferences among patients with language and literacy self-management barriers.
• Discuss the public health implications of tailoring diabetes self-management in safety-net systems.

Keywords: Health Literacy, Technology

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation