title: Seeing in 3-D: examining the reach of diabetes self-management support strategies in a public health care system.
abstract: The authors examined whether tailored self-management support (SMS) strategies reach patients in a safety net system and explored variation by language, literacy, and insurance. English-, Spanish-, and Cantonese-speaking diabetes patients were randomized to weekly automated telephone disease management (ATDM) or monthly group medical visits. The SMS programs employ distinct communication methods but share common objectives, including behavioral "action plans." Reach was measured using three complementary dimensions: (a) participation among clinics, clinicians, and patients; (b) patient representativeness; and (c) patient engagement with SMS. Participation rates were high across all levels and preferentially attracted Spanish-language speakers, uninsured, and Medicaid recipients. Although both programs engaged a significant proportion in action planning, ATDM yielded higher engagement, especially among those with limited English proficiency and limited literacy. These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities.
authors.affiliation: University of California, San Francisco Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA 94110, USA. dschillinger@medsfgh.ucsf.edu
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Hali
authors.initials: H
authors.lastname: Hammer
authors.forename: Frances
authors.initials: F
authors.lastname: Wang
authors.forename: Jorge
authors.initials: J
authors.lastname: Palacios
authors.forename: Ivonne
authors.initials: I
authors.lastname: McLean
authors.forename: Audrey
authors.initials: A
authors.lastname: Tang
authors.forename: Sharon
authors.initials: S
authors.lastname: Youmans
authors.forename: Margaret
authors.initials: M
authors.lastname: Handley
mesh_terms: D000328:Adult; D000368:Aged; D019090:Case Management; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006126:Group Processes; D006801:Humans; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D009720:Nurse Clinicians; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care; D012648:Self Care; D012944:Social Support; D013689:Telephone; D014481:United States; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human