title: Patient understanding of diabetes self-management: participatory decision-making in diabetes care.
abstract: OBJECTIVE
  Our aim was to determine whether patient participation in decision-making about diabetes care is associated with understanding of diabetes self-management and subsequent self-care practices. We also identified issues that would impact messaging for use in mobile diabetes communication.
  
  
  METHODS
  A cross-sectional observational study was conducted with type 2 diabetes patients (n = 81) receiving their care at the University of Maryland Joslin Diabetes Center. A convenience sample of patients were eligible to participate if they were aged 25-85 years, had type 2 diabetes, spoke English, and visited their physician diabetes manager within the past 6 months. In-person patient interviews were conducted at the time of clinic visits to assess patient understanding of diabetes management, self-care practices, and perceptions of participation in decision-making about diabetes care.
  
  
  RESULTS
  African Americans reported fewer opportunities to participate in decision-making than Caucasians, after controlling for education [mean difference (MD) = -2.4, p = .02]. This association became insignificant after controlling for patient-physician race concordance (MD = -1.5, p = .21). Patient understanding of self-care was predicted by having greater than high school education (MD = 3.6, p = .001) and having physicians who involved them in decision-making about their care. For each unit increase in understanding of diabetes self-care, the mean patient self-care practice score increased by 0.16 (p = .003), after adjustment for patient race and education.
  
  
  CONCLUSIONS
  Patient participation in decision-making is associated with better understanding of care. Participation in decision-making plays a key role in patient understanding of diabetes self-management and subsequent self-care practices. Patients with limited education need specific instruction in foot care, food choices, and monitoring hemoglobin A1c.
authors: Department of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine, Baltimore, Maryland, USA. cquinn@epi.umaryland.edu
authors: Charlene C
authors: CC
authors: Quinn
authors: Renee
authors: R
authors: Royak-Schaler
authors: Dan
authors: D
authors: Lender
authors: Nanette
authors: N
authors: Steinle
authors: Shahinaz
authors: S
authors: Gadalla
authors: Min
authors: M
authors: Zhan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D010865:Pilot Projects; D012107:Research Design; D017216:Telemedicine / Q000379:methods