title: Keys to successful diabetes self-management for uninsured patients: social support, observational learning, and turning points: a safety net providers' strategic alliance study.
abstract: OBJECTIVE
  To examine how medically uninsured patients who receive health care at federally qualified health centers and free clinics are able to successfully self-manage diabetes compared to patients who are less successful.
  
  
  METHODS
  Two distinct groups of patients with diabetes for 6 months or longer were enrolled: (1) successful, defined as those with glycated hemoglobin (HbA1c) of 7% or less or a recent improvement of at least 2% (n=17); and (2) unsuccessful, defined as patients with HbAlc of at least 9% (n=9) and without recent improvement. Patients were interviewed about enabling factors, motivators, resources, and barriers to diabetes self-management. Data from interviews, chart reviews, and clinician surveys were analyzed using qualitative methods and statistical techniques.
  
  
  RESULTS
  African Americans comprised 57.7% of the sample and whites 38.5% (N=26). No significant differences were detected between successful and unsuccessful groups in age, race, education, or employment status. Clinicians rated unsuccessful patients as having more severe diabetes and significantly lower levels of control than successful patients. Compared to unsuccessful patients, successful patients more often reported having friends or family with diabetes, more frequently sought information about the disease, used evidence-based self-management strategies, held more accurate perceptions of their own diabetes control, and experienced "turning point" events that motivated increased efforts in disease management.
  
  
  CONCLUSIONS
  Patients who successfully managed diabetes learned from diabetic family members and interpreted disease-related events as motivational turning points. It may be beneficial to incorporate social learning and motivational enhancement into diabetes interventions to increase patients' motivation for improved levels of self-management.
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Melissa Hanahan
authors.initials: MH
authors.lastname: Madden
authors.forename: Philip
authors.initials: P
authors.lastname: Tomsik
authors.forename: Joshua
authors.initials: J
authors.lastname: Terchek
authors.forename: Lisa
authors.initials: L
authors.lastname: Navracruz
authors.forename: Ann
authors.initials: A
authors.lastname: Reichsman
authors.forename: Terri Clemons
authors.initials: TC
authors.lastname: Clark
authors.forename: Peggi
authors.initials: P
authors.lastname: Cella
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Weirich
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Munson
authors.forename: James J
authors.initials: JJ
authors.lastname: Werner
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D019370:Observation; D012648:Self Care; D012944:Social Support; D017664:Uncompensated Care; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin