Impact of Limited English Proficiency on Self-Management of Diabetes among Individuals in California from 2009-2012 Open Access

Ng, Carmen Stephanie (2015)

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Type 2 diabetes is an epidemic that not only is growing in prevalence, but also has detrimental consequences including kidney disease and blindness. Although self-management is one way to assist in decreasing morbidity and mortality due to diabetes, there are many barriers along the pathway to successful self-management. This study examined the association between limited English proficiency (LEP), a common communication barrier, and self-management. We analyzed two cycles of data collected by the California Health Interview Survey (2009, 2011-2012). Using multivariate logistic regressions, we assessed the relationship of LEP with process indicators including usual source of care, receipt of care plan (either receipt of a physical copy or discussion of care plan), and self-efficacy; and we further assessed the relationship of these factors with three indicators of diabetes self-management: biannual foot examinations, annual eye examinations, and self-monitoring of blood glucose. LEP individuals were less likely to have a usual source of care (OR: 0.344, 95% CI: 0.150, 0.791) and less likely to discuss or have a written care plan (OR: 0.529, 95% CI: 0.324, 0.865; OR: 0.427, 95%CI: 0.241, 0.758). They were also 38% (OR: 0.624, 95% CI: 0.403, 0.967) less likely to comply with self-monitoring blood glucose guidelines. English proficiency was not a significant predictor for self-efficacy or for foot and eye examinations. Diabetics with LEP status were less likely to have a usual source of care, to have received a care plan to manage their disease, and to be adhering to guidelines about self-monitoring of blood glucose. The receipt of a care plan is a significant predictor of adherence to all self-management actions measured in this study. Our results are consistent with previous studies indicating the importance of the care plan. Efforts to discuss and distribute a care plan should be encouraged in all medical interactions for all diabetic individuals, and this may be especially important for those without a usual source of care. Our results also revealed pervasive effects of LEP on self-management behaviors. This study suggests prioritization of vulnerable and increasing LEP populations through increasing access to healthcare and reducing communication barriers through medical interpreters.

Table of Contents

Introduction 1

Literature Review 2

Diabetes in the United States 2

Self-Management 3

Barriers to Self-Management 4

Methodology 6

Study Objective and Research Questions 6

Data Source 7

Theoretical Framework 8

Measurement 10

Key Variables 10

Cues to Action 11

Self-Efficacy 11

Self-Management Indicators 12

Moderating Factors 12

Focal Relationships 16

Statistical Analysis 17

Analytic Strategy 17

Sensitivity Analyses 19

Results 19

Descriptive Statistics 19

Research Question 1: Does English proficiency predict usual source of care for individuals with diabetes? 22

Research Question 2: Does English proficiency predict receipt of care plan for individuals with diabetes? 24

Research Question 3: Does English proficiency predict self-efficacy in diabetic individuals? 27

Research Question 4: Does English proficiency predict self-management actions for individuals with diabetes? 30

Sensitivity Analyses 38

Discussion 39

Key Findings 39

Clinical Implications 40

Policy Implications 41

Limitations 42

Further Research 43

Conclusion 45

References 46

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