Self-management is an important part of diabetes care. In order to be successful, however, support services need to be in place to help patients with their specific, ongoing needs. Researchers at the University of California, San Francisco Center for Vulnerable Populations, have found that tailoring self-management support (SMS) through the use of a simple automated communication technology is very effective at reaching traditionally "hard-to-reach" individuals, particularly those with language, literacy, and insurance challenges.
The researchers investigated two SMS strategies. The first was an automated telephone self-management support system. Patients in this intervention received weekly, prerecorded telephone calls in their native language (English, Spanish, or Cantonese) over a period of 9 months. Each call lasted 6 to 12 minutes, and participants responded to diabetes-related questions. Based on their answers, the patients received either tailored, immediate health education or subsequent callbacks from a nurse care manager who helped them solve any issues using goal setting and action plans. A second set of patients received monthly support meetings over a period of 9 months. During these 90-minute group interventions, a physician and health educator focused on diabetes-related goal setting and action plans. The sessions involved 6 to 10 patients and were conducted in their native language.
The automated telephone call intervention reached a much greater proportion of the target population compared with the group medical intervention. Participation rates were high across clinic, clinician, and patient levels. There were especially high levels of participation among the uninsured and patients who were non-English language speakers and those who had limited literacy, in terms of call responses and action plan generation. In contrast, the group medical visit intervention had lower participation among patients with communication barriers.
The researchers suggest that by employing simple communication technologies to deliver more care to patients with greater needs, public health and health care systems can help reduce disparities in diabetes care in individuals with communication barriers. The study was supported in part by the Agency for Healthcare Research and Quality (HS14864).
See "Seeing in 3-D: Examining the reach of diabetes self-management support strategies in a public health care system," by Dean Schillinger, M.D., Hali Hammer, M.D., Frances Wang, M.S., and others, in the October 2008 Health Education & Behavior 35, pp. 664-682.