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 determine how medically uninsured patients with limited material resources successfully manage diabetes. Methods Clinicians at 5 safety net practices enrolled uninsured adult patients (N=26) with prior diagnosis of diabetes for 6 months or longer. Patients were interviewed about enabling factors, motivations, resources, and barriers. Chart reviews and clinician surveys supplemented interview data. Interview, survey, and chart review data were analyzed and findings were summarized. Results Two distinct groups of patients were investigated: 1) “successful,” defined as those with an HbA1c of ≤7% or a recent improvement of at least 2% (n=17); and 2) “unsuccessful,” defined as patients with HbA1c of ≥9% (n=9) without recent improvement. In comparison to unsuccessful patients, successful patients more often reported having friends or family with diabetes, sought information about the disease, used evidence-based self-management strategies, held an accurate perception of their own disease control, and experienced “turning point” events that motivated increased efforts in disease management. Conclusions Uninsured safety net patients who successfully managed diabetes learned from friends and family with diabetes and leveraged disease-related events into motivational turning points. It may be beneficial for clinicians to incorporate social learning and motivational enhancement into diabetes interventions to increase patients’ motivation for improved levels of self-management.

Family behaviours that have an impact on the self‐management activities of adults living with Type 2 diabetes: a systematic review and meta‐synthesis

“…). More than half the studies were conducted in high‐income countries ( n =25; Table ). Half of the studies ( n =22) focused on culturally and linguistically diverse or disadvantaged populations.…”

“…The quality of the studies was variable. Most studies clearly described their research aims, design and methodology, but only a few described the study setting , or reported whether data saturation had been reached . The sampling approach in three studies was unclear .…”

Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus

“…The accessibility for health insurance remains suboptimal despite recent changes in health care reform ( 35 ). The lack of health insurance has been associated with poor health outcomes and reduced quality of life among adults who suffer from chronic diseases, particularly diabetes ( 35 , 36 ).…”

Culture and Food Practices of African American Women With Type 2 Diabetes

“…Of the 21 studies, 6 were eliminated as follows: (a) all participants did not have T2DM (Kieffer et al, 2004); (b) focus group questioning did not obtain information regarding diabetes and dietary practices (Madden et al, 2011); (c) one study was an intervention study only (Carter, Nunlee-Bland, & Callender, 2011); (d) two studies focused on AA and diet but were not diabetes focused (James, 2004;Atkinson et al, 2009); and (e) one study examined the barriers to following dietary recommendations with T2DM, but the participants were majority Caucasian (Vijan et al, 2004). A total of 15 studies was examined and included for this review: 13 focus group/interview type studies and two ethnographic studies.…”