title: Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes.
abstract: OBJECTIVE
  Patient-provider communication about complementary health approaches can support diabetes self-management by minimizing risk and optimizing care. We sought to identify sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes.
  
  
  METHODS
  We used data from San Francisco Health Plan's SMARTSteps Program, a trial of diabetes self-management support for low-income patients (n=278) through multilingual automated telephone support. Interviews collected use and disclosure of complementary health approaches in the prior month, patient-physician language concordance, and quality of communication.
  
  
  RESULTS
  Among racially, linguistically diverse participants, half (47.8%) reported using complementary health practices (n=133), of whom 55.3% disclosed use to providers. Age, sex, race/ethnicity, nativity, education, income, and health literacy were not associated with disclosure. In adjusted analyses, disclosure was associated with language concordance (AOR=2.21, 95% CI: 1.05, 4.67), physicians' interpersonal communication scores (AOR=1.50, 95% CI: 1.03, 2.19), shared decision making (AOR=1.74, 95% CI: 1.33, 2.29), and explanatory-type communication (AOR=1.46, 95% CI: 1.03, 2.09).
  
  
  CONCLUSIONS
  Safety net patients with diabetes commonly use complementary health approaches and disclose to providers with higher patient-rated quality of communication.
  
  
  CONCLUSIONS
  Patient-provider language concordance and patient-centered communication can facilitate disclosure of complementary health approaches.
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Maria.Chao@ucsf.edu.
authors.forename: M T
authors.initials: MT
authors.lastname: Chao
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Handley
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Quan
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: U
authors.initials: U
authors.lastname: Sarkar
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Ratanawongsa
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D003695:Delivery of Health Care; D003920:Diabetes Mellitus; D030881:Disclosure; D005260:Female; D006801:Humans; D008297:Male; D008483:Medical Assistance; D008875:Middle Aged; D010817:Physician-Patient Relations; D011203:Poverty; D044469:Racial Groups
keywords: Complementary and alternative medicine; Complementary health approaches; Diabetes; Disclosure; Health communication; Health disparities; Integrative medicine; Limited English proficiency