title: Barriers to diabetes education in urban patients: perceptions, patterns, and associated factors.
abstract: This study explored patients' perceptions of barriers to diabetes education among a mostly African American population of adults with diabetes.
  
  
  
  A survey was conducted among 605 new patients attending an urban outpatient diabetes clinic. The questionnaire gathered information on issues patients believed would adversely affect their ability to learn about diabetes. The type and frequency of education barriers were evaluated, and variables associated with reporting an obstacle were analyzed.
  
  
  
  Average patient age was 50 years, diabetes duration was 5.6 years, body mass index was 32 kg/m2, and hemoglobin A1C was 9.1%. The majority (56%) were women, 89% were African American, and 95% had type 2 diabetes. Most respondents (96%) had received some prior instruction in diabetes care; however, 53% anticipated future difficulties learning about diabetes. The most commonly cited concerns were poor vision (74%) and reading problems (29%). Patients with a perceived barrier to diabetes education were older (P < .001) than were persons without a barrier, and they differed in both employment and educational status (both P < .001). In adjusted analyses, older age, male gender, being disabled, and having an elementary education or less were associated with a significantly increased likelihood of having a barrier to diabetes education, whereas having a college education decreased the odds. Higher hemoglobin A1C levels also tended to be associated with a greater chance of reporting an education barrier (P = .05).
  
  
  
  A substantial number of persons anticipated a barrier to diabetes education. Interventions at multiple levels that address the demographic and socioeconomic obstacles to diabetes education are needed to ensure successful self-management training.
authors.affiliation: The Department of Medicine, Emory University, Atlanta, Georgia (Dr Rhee, Dr El-Kebbi)
authors.forename: Mary K
authors.initials: MK
authors.lastname: Rhee
authors.affiliation: The Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona (Dr Cook)
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
authors.affiliation: The Department of Medicine, Emory University, Atlanta, Georgia (Dr Rhee, Dr El-Kebbi)
authors.forename: Imad
authors.initials: I
authors.lastname: El-Kebbi
authors.affiliation: The Department of Biostatistics, Emory University, Atlanta, Georgia (Dr Lyles)
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lyles
authors.affiliation: The Grady Health System, Atlanta, Georgia (Ms Dunbar, Ms Panayioto, Ms Berkowitz, Ms Boyd, Ms Broussard, Mr George)
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Dunbar
authors.affiliation: The Grady Health System, Atlanta, Georgia (Ms Dunbar, Ms Panayioto, Ms Berkowitz, Ms Boyd, Ms Broussard, Mr George)
authors.forename: Rita M
authors.initials: RM
authors.lastname: Panayioto
authors.affiliation: The Grady Health System, Atlanta, Georgia (Ms Dunbar, Ms Panayioto, Ms Berkowitz, Ms Boyd, Ms Broussard, Mr George)
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Berkowitz
authors.affiliation: The Grady Health System, Atlanta, Georgia (Ms Dunbar, Ms Panayioto, Ms Berkowitz, Ms Boyd, Ms Broussard, Mr George)
authors.forename: Barbara
authors.initials: B
authors.lastname: Boyd
authors.affiliation: The Grady Health System, Atlanta, Georgia (Ms Dunbar, Ms Panayioto, Ms Berkowitz, Ms Boyd, Ms Broussard, Mr George)
authors.forename: Sandra
authors.initials: S
authors.lastname: Broussard
authors.affiliation: The Grady Health System, Atlanta, Georgia (Ms Dunbar, Ms Panayioto, Ms Berkowitz, Ms Boyd, Ms Broussard, Mr George)
authors.forename: Christopher D
authors.initials: CD
authors.lastname: George
mesh_terms: D001741:Black or African American / Q000193:education / Q000208:ethnology; D000367:Age Factors; D001294:Attitude to Health / Q000208:ethnology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000517:prevention & control*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards*; D006766:Hospitals, County; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic / Q000592:standards*; D012648:Self Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health