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

Abstract

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management
Keyword	diabetes self-efficacy limited English proficiency
Committee Chair / Thesis Advisor	Lipscomb, Joseph, Emory University
Committee Members	Rask, Kimberly J, Emory University Gaydos, Laurie, Emory University Jacobson, Kara L, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs University, college or educational institution (other than Emory)

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