title: The influence of literacy on patient-reported experiences of diabetes self-management support.
abstract: BACKGROUND
  Variability in disease-related outcomes may relate to how patients experience self-management support in clinical settings.
  
  
  OBJECTIVE
  The purpose of this study was to identify factors associated with experiences of self-management support during primary care encounters.
  
  
  METHODS
  A cross-sectional survey was conducted of 208 patients seen in a multidisciplinary diabetes program in an academic medicine clinic. Multiple regression analysis was used to test associations between patient-rated experiences of self-management support (Patient Assessment of Chronic Illness Care) and race, gender, insurance status, literacy, duration of diabetes, and intensity of care management.
  
  
  RESULTS
  The Patient Assessment of Chronic Illness Care ratings decreased with age (r = -.235, p = .001), were higher for women than for men (3.95 vs. 3.65, t = 2.612, p= .010), and were greater for those with more education (F= 3.927, p = .009) and greater literacy skills (t = 3.839, p< .001). The ratings did not vary between racial (t = -1.108, p = .269) or insurance (F = 1.045, p = .374) groups and were unaffected by the duration of diabetes (r= .052, p = .466) and the intensity of care management (F = 1.028, p = .360). In multivariate models, literacy was the only variable contributing significantly to variation in self-management support ratings.
  
  
  CONCLUSIONS
  Even when considering the objective intensity of health services delivered, literacy was the sole variable contributing to differences in patient ratings of self-management support. Although conclusions are limited by the cross-sectional nature of this study, the results emphasize the need to consider literacy when developing and communicating treatment plans requiring self-management skills.
authors.affiliation: College of Nursing, University of Iowa, Iowa City, IA 52242, USA. andrea-wallace@uiowa.edu
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Wallace
authors.forename: John R
authors.initials: JR
authors.lastname: Carlson
authors.forename: Robb M
authors.initials: RM
authors.lastname: Malone
authors.forename: James
authors.initials: J
authors.lastname: Joyner
authors.forename: Darren A
authors.initials: DA
authors.lastname: Dewalt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000451:nursing*; D019468:Disease Management; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D012648:Self Care / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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