title: Health care and patient-reported outcomes: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study.
abstract: OBJECTIVE
  The purpose of this study was to assess the relationship of patients' self-reported well-being, self-management, and diabetes control with factors related to the patient's health care.
  
  
  METHODS
  This was a cross-sectional survey of national samples of patients with diabetes (n = 5,104) from the multinational study of Diabetes Attitudes, Wishes and Needs (DAWN). Patients from 13 countries in Asia, Australia, Europe, and North America reported their level of well-being, self-management, and diabetes control. Hierarchical multiple regression analysis (blocks are countries, respondent characteristics, and health care features) was used to examine predictors of diabetes-related distress and general well-being, adherence to lifestyle and medical treatment recommendations, and perceived diabetes control and hyperglycemic symptoms.
  
  
  RESULTS
  Country, respondent demographic and disease characteristics, and health care features were all associated with patient-reported outcomes. Better patient-provider collaboration was associated with more favorable ratings on all outcomes, and better access to the provider and availability of team care were associated with some positive outcomes. Country differences were only partly accounted for by patient and health care factors. Relationships between health care factors and outcomes varied across countries.
  
  
  CONCLUSIONS
  Patients' reports of well-being, self-management, and diabetes control were related to the countries in which they live, their demographic and disease characteristics, and features of their health care. Opportunities to enhance patient-provider collaboration, access to care, and availability of team care should be pursued.
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, MD., USA. rrubin443@aol.com
authors.forename: Richard R
authors.initials: RR
authors.lastname: Rubin
authors.forename: Mark
authors.initials: M
authors.lastname: Peyrot
authors.forename: Linda M
authors.initials: LM
authors.lastname: Siminerio
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003710:Demography; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology; D003920:Diabetes Mellitus / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012044:Regression Analysis; D012107:Research Design; D012648:Self Care; D016896:Treatment Outcome