Disease Management Advice Provided to African-American and Chinese-American Patients With Type 2 Diabetes
- Lawrence Fisher, PHD1,
- Marilyn M. Skaff, PHD1,
- Catherine A. Chesla, RN, DNSC2,
- Kevin M. Chun, PHD3,
- Joseph T. Mullan, PHD4,
- Richard A. Kanter, MD, FACE5 and
- Phillip S. Gardiner, DPH5
- 1Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
- 2Department of Family Health Care Nursing, University of San Francisco, San Francisco, California
- 3Department of Psychology, University of San Francisco, California
- 4Department of Social and Behavioral Sciences, Northern California Kaiser Permanente Medical Group, San Francisco, California
- 5Office of the President, University of California, Oakland, California
- Address correspondence and reprint requests to Lawrence Fisher, PhD, Department of Family and Community Medicine, Box 0900, University of California, San Francisco, San Francisco, CA 94143. E-mail: fisher{at}itsa.ucsf.edu
Patients from diverse communities with diabetes have poorer glycemic control (1) and more complications (2) than other patients with diabetes. Ethnicity alone, however, is insufficient to account for these differences because considerable within-group variation also occurs (3). To gain a better understanding of factors that contribute to this variation, we asked African-American and Chinese-American patients with type 2 diabetes what they had been advised to do to manage their disease by their diabetes practitioners and linked their responses to their reports of actual behavior. We also investigated what factors accounted for differences in reported advice received among members of each community. Understanding these issues highlights deficits in informational exchange for these populations and identifies characteristics of minority patients that place them at risk of not obtaining specific kinds of disease-management information.
RESEARCH DESIGN AND METHODS
As part of a larger study (3,4), patients who met the following inclusion criteria were identified from 10 community health care settings: a diagnosis of type 2 diabetes for at least 1 year, age between 25 and 70 years, no evidence of major diabetes complications, living in the U.S. for a minimum of 1 year, and self-identified as Chinese American (born in the U.S. or Asia) or African American (born in the U.S.).
Screening identified 412 eligible Chinese-American patients, and 194 agreed to participate (47%). This modest acceptance rate is consistent with past reports on the many challenges of obtaining a high response rate among Asian Americans (11). Screening identified 300 eligible African-American patients, and 205 agreed to participate (68%). Complete …
