title: Differences in self-management behaviors and use of preventive services among diabetes management enrollees by race and ethnicity.
abstract: We assessed the degree that managed care organization (MCO) enrollees used preventive services and engaged in diabetes self-management behaviors by race/ethnicity. A 40-item selfadministered survey was mailed to 19,483 diabetic MCO enrollees. The survey measured use of eight preventive services and engagement in four self-management behaviors among enrollees who self-identified as black, white, or Hispanic. Of the 6,035 surveys analyzed, 4,623 respondents (76.6%) were white, 984 (16.3%) were black, and 428 (7.0%) were Hispanic. Black and Hispanic respondents reported more healthcare visits (mean of 7.0 and 6.5, respectively) in the past year compared to whites (mean, 5.7; p < 0.0001). However, compared to whites, blacks had significantly lower utilization of five of the eight preventive services measured, and Hispanics had significantly lower utilization of seven of the eight preventive services (p < 0.005). With regard to self-management behaviors, blacks were significantly less likely than whites to monitor their diet (65.9% vs. 73.7%, p < 0.0001), exercise (46.4% vs. 52.8%; p = 0.0004) and not smoke (85.1% vs. 89.3%; p = 0.0002); while Hispanics were less likely to monitor their diet (67.3% vs. 73.7%, p = 0.0051). All racial/ethnic groups had low levels of selfmanagement behaviors. Further research is warranted to identify why disparities remain in settings where services are universally available, and to find practical ways to eliminate disparities in a group with routine healthcare encounters.
authors.affiliation: Emory Center on Health Outcomes and Quality (ECHOQ), Rollins School of Public Health, Atlanta, Georgia 30322, USA. noster@sph.emory.edu
authors.forename: Natalia Vukshich
authors.initials: NV
authors.lastname: Oster
authors.forename: Verna
authors.initials: V
authors.lastname: Welch
authors.forename: Laura
authors.initials: L
authors.lastname: Schild
authors.forename: Julie A
authors.initials: JA
authors.lastname: Gazmararian
authors.forename: Kimberly
authors.initials: K
authors.lastname: Rask
authors.forename: Claire
authors.initials: C
authors.lastname: Spettell
mesh_terms: D001741:Black or African American; D003920:Diabetes Mellitus / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D005006:Ethnicity; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data; D044469:Racial Groups; D012648:Self Care; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People