title: Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting.
abstract: OBJECTIVE
  Diabetes patients with limited resources often experience suboptimal care. Less is known about the role of effective health communication (HC) in caring for low income diabetes patients.
  
  
  METHODS
  Ten health department clinics in TN participated in a trial evaluating a literacy-sensitive communication intervention. We assessed the quality of baseline HC and measured associations with diabetes outcomes. Assessments included: demographics, measures of HC, health literacy, self-care behaviors, self-efficacy, medication non-adherence, treatment satisfaction, and A1C. Unadjusted and adjusted multivariable regression models were used to test associations.
  
  
  RESULTS
  Participants (N=411) were 49.7±9.5 years, 61% female, uninsured (96%), with A1C 9.6±2.1. In unadjusted analyses, better communication, was associated with lower medication non-adherence (OR 0.40-0.68, all p<0.05), higher treatment satisfaction (OR 1.76-1.96, all p<0.01), portion size reduction (OR 1.43, p<0.05), diabetes self-efficacy (OR 1.41, p<0.05), and lower A1C (β=-0.06, p<0.01). In adjusted analyses, communication quality remained associated with lower medication non-adherence (AOR 0.39-0.68, all p<0.05), and higher treatment satisfaction (AOR 1.90-2.21, all p<0.001).
  
  
  CONCLUSIONS
  Better communication between low-income patients and providers was independently associated with lower medication non-adherence and higher treatment satisfaction.
  
  
  CONCLUSIONS
  Communication quality may be an important modifiable approach to improving diabetes care for vulnerable populations.
authors.affiliation: Division of Community Internal Medicine, Mayo Clinic, Jacksonville, USA; Department of Family Medicine, Mayo Clinic, Jacksonville, USA. Electronic address: white.richard@mayo.edu.
authors.forename: Richard O
authors.initials: RO
authors.lastname: White
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Eden
authors.affiliation: School of Nursing, Vanderbilt University Medical Center, Nashville, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA.
authors.forename: Shari
authors.initials: S
authors.lastname: Barto
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, USA.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D058015:Health Communication; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010549:Personal Satisfaction; D011203:Poverty / Q000523:psychology; D012648:Self Care; D020377:Self Efficacy; D013714:Tennessee; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Diabetes; Health communication; Primary care; Provider education; Public health