The influence of literacy on patient-reported experiences of diabetes self-management support.
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.
Wallace
Andrea S
AS
College of Nursing, University of Iowa, Iowa City, IA 52242, USA. andrea-wallace@uiowa.edu
Carlson
John R
JR
Malone
Robb M
RM
Joyner
James
J
Dewalt
Darren A
DA
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
Diabetes Educ. 2005 Sep-Oct;31(5):712-8
16203855
Lancet. 1998 Sep 12;352(9131):837-53
9742976
Patient Educ Couns. 1999 Sep;38(1):33-42
14528569
Ann Pharmacother. 2008 Sep;42(9):1272-81
18648014
J Rural Health. 2005 Fall;21(4):317-21
16294654
Natl Health Stat Report. 2008 Aug 6;(8):1-29
18958997
J Gen Intern Med. 2008 Jan;23(1):77-80
18030539
J Gen Intern Med. 2004 Dec;19(12):1228-39
15610334
Curr Diab Rep. 2002 Apr;2(2):160-5
12643135
Fam Med. 1993 Jun;25(6):391-5
8349060
Diabetes Care. 2009 Jan;32 Suppl 1:S13-61
19118286
Patient Educ Couns. 2004 Mar;52(3):315-23
14998602
Health Educ Behav. 2008 Oct;35(5):664-82
17513690
South Med J. 2004 Feb;97(2):145-8
14982263
Nutr Metab Cardiovasc Dis. 2009 Jan;19(1):45-53
18450436
Med Care. 2005 May;43(5):436-44
15838407
JAMA. 2002 Oct 16;288(15):1909-14
12377092
Health Serv Res. 2005 Apr;40(2):361-72
15762896
Qual Manag Health Care. 2008 Jan-Mar;17(1):47-52
18204377
Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
11816692
Am J Public Health. 2000 Mar;90(3):431-4
10705866
Gend Med. 2008 Jun;5(2):162-80
18573483
J Gen Intern Med. 2005 Feb;20(2):185-92
15836553
Public Health Rep. 2006 May-Jun;121(3):245-54
16640146
Diabetes Educ. 2004 Mar-Apr;30(2):263-73
15095516
Diabetes Care. 2005 Apr;28(4):816-22
15793179
Diabetes Care. 2005 Nov;28(11):2655-61
16249535
Med Care. 2004 Feb;42(2):102-9
14734946
Jt Comm J Qual Improv. 2001 Feb;27(2):63-80
11221012
Eff Clin Pract. 2001 Nov-Dec;4(6):278-80
11769301
Lancet. 1998 Sep 12;352(9131):854-65
9742977
J Altern Complement Med. 2005;11 Suppl 1:S7-15
16332190
JAMA. 2004 Oct 13;292(14):1711-6
15479936
Am J Manag Care. 2006 May;12(5):277-83
16686585
BMJ. 2001 Oct 27;323(7319):945-6
11679369
Health Serv Res. 2002 Jun;37(3):791-820
12132606
J Nurs Scholarsh. 2004;36(1):66-72
15098421
Diabetes Educ. 2009 Mar-Apr;35(2):246-8, 252-6, 258-63
19208816
Diabetes Educ. 2005 Mar-Apr;31(2):225-34
15797851
BMJ. 2006 Jul 1;333(7557):19
16793783
Prim Care Diabetes. 2008 Feb;2(1):39-44
18684419
Med Care. 2000 Mar;38(3):325-34
10718357
Qual Prim Care. 2009;17(5):351-7
20003721
JAMA. 2002 Oct 9;288(14):1775-9
12365965
Diabetes Care. 2006 Mar;29(3):531-7
16505501
JAMA. 2002 Jul 24-31;288(4):475-82
12132978
J Gen Intern Med. 1995 Oct;10(10):537-41
8576769