Studies on self-management among patients with diabetes continue to appear in increasing numbers. Sarker and coworkers sought to identify interest in different modes of self-management support among diabetes patients cared for in public hospitals, and to assess whether demographic or disease-specific factors were associated with patient preferences. The investigators were also interested in the role of a perceived communication need in influencing interest in self-management support. A telephone survey of a random sample of 796 English and Spanish-speaking diabetes patients recruited from four urban US public hospital systems were conducted. The association of race/ethnicity, primary language, self-reported health literacy, self-efficacy, and diabetes-related factors on patients' interest in three self-management strategies (telephone support, group medical visits, and Internet-based support) was explored. This included looking at the extent patients believed that better communication with providers would improve their diabetes control, and whether this perception altered the relationship between patient factors and self-management support acceptance. Sixty-nine percent of respondents reported interest in telephone support, 55% in-group medical visits, and 42% in the Internet. Compared to Non-Hispanic Whites, Spanish-speaking Hispanics were more interested in telephone support and group medical visits, but less interested in Internet self-management? African-Americans were more interested than whites in all three self-management support strategies. Patients with limited self-reported health literacy were more likely to be interested in telephone support than those not reporting literacy deficits. Forty percent reported that their diabetes would be better controlled if they communicated better with their health care provider. This perceived communication was independently associated with interest in self-management support, but its inclusion in the different approaches did not alter the strengths of the main associations between patient characteristics and self-management support preferences.

VALUE OF STUDY TO READER: The authors concluded that many diabetic patients in safety-net settings reported an interest in receiving self-management support, but those preferences for delivery of self-management varied by race/ethnicity, language proficiency, and self-reported health literacy. Many self-management programs are increasingly being delivered via the telephone and the Internet. These trends can be expected to continue. However, an issue greater than the delivery of a self-management program is how to assess patient performance of self-management skills in the natural environment, particularly over time and setting.

S Sarker et al. Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems. Patient Education and Counseling, November 6, 2007.