Monday, March 17
Tom Vogl: Differential Fertility, Human Capital, & Development
Heisler, Michele, John D. Piette, Michael Spencer, Edie Kieffer, and Vijan Sandeep. 2005. "The Relationship Between Knowledge of Recent HbA1c Values and Diabetes Care Understanding and Self-Management." Diabetes Care, 28:816-822.
OBJECTIVE- Knowledge of one's actual and target health outcomes (such as HbA^sub 1c^ values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one's most recent HbA^sub 1c^ test result and 2) whether knowing one's HbA^sub 1c^ value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control. RESEARCH DESIGN AND METHODS- We conducted a cross-sectional survey of a sample of 686 U.S. adults with type 2 diabetes in five health systems who had HbA^sub 1c^ checked in the previous 6 months. Independent variables included patient characteristics, health care provider communication, and health system type. We examined bivariate and multivariate associations between each variable and the respondents' knowledge of their last HbA^sub 1c^ values and assessed whether knowledge of HbA^sub 1c^ was associated with key diabetes care attitudes and behaviors. RESULTS- Of the respondents, 66% reported that they did not know their last HbA^sub 1c^ value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA^sub 1c^ knowledge. Respondents who knew their last HbA^sub 1c^ value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05-2.42) and better reported understanding of their diabetes care (P < 0.001). HbA^sub 1c^ knowledge was not associated with respondents' diabetes care self-efficacy or reported self-management behaviors. CONCLUSIONS- Respondents who knew their HbA^sub 1c^ values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one's HbA^sub 1c^ level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients' diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes.
Country of focus: United States.