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Health Education & Behavior
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Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System

Dean Schillinger, MD

University of California, San Francisco (UCSF) Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital, dschillinger{at}medsfgh.ucsf.edu

Hali Hammer, MD

UCSF Department of Family and Community Medicine, San Francisco General Hospital

Frances Wang, MS

UCSF Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital

Jorge Palacios, MA

UCSF Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital

Ivonne McLean, BA

UCSF Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital

Audrey Tang, MS, NP

UCSF Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital

Sharon Youmans, DrPharm

UCSF School of Pharmacy, San Francisco

Margaret Handley, PhD, MPH

UCSF Department of Family and Community Medicine, San Francisco General Hospital

The authors examined whether tailored self-management support (SMS) strategies reach patients in a safety net system and explored variation by language, literacy, and insurance. English-, Spanish-, and Cantonese-speaking diabetes patients were randomized to weekly automated telephone disease management (ATDM) or monthly group medical visits. The SMS programs employ distinct communication methods but share common objectives, including behavioral "action plans." Reach was measured using three complementary dimensions: (a) participation among clinics, clinicians, and patients; (b) patient representativeness; and (c) patient engagement with SMS. Participation rates were high across all levels and preferentially attracted Spanish-language speakers, uninsured, and Medicaid recipients. Although both programs engaged a significant proportion in action planning, ATDM yielded higher engagement, especially among those with limited English proficiency and limited literacy. These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities.

Key Words: translational research • diabetes mellitus • disparities • health communication • literacy • chronic disease care • self-management • information technology

This version was published on October 1, 2008

Health Education & Behavior, Vol. 35, No. 5, 664-682 (2008)
DOI: 10.1177/1090198106296772
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D. Schillinger, M. Handley, F. Wang, and H. Hammer
Effects of Self-Management Support on Structure, Process, and Outcomes Among Vulnerable Patients With Diabetes: A three-arm practical clinical trial
Diabetes Care, April 1, 2009; 32(4): 559 - 566.
[Abstract] [Full Text] [PDF]