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BMC Public Health. 2012; 12: 185.
Published online Mar 12, 2012. doi:  10.1186/1471-2458-12-185
PMCID: PMC3362774
Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States
Joan A Vaccaro,1 Daniel J Feaster,2 Sandra L Lobar,3 Marianna K Baum,1 Marcia Magnus,1 and Fatma G Huffmancorresponding author1,4
1Robert Stempel College of Public Health and Social Work; Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
2Department of Epidemiology and Public Health; Miller School of Medicine, University of Miami, 1120 NW 14th Street, Room 1055, Miami, FL 33136, USA
3College of Nursing and Health Sciences; Department of Nursing, Florida International University, Miami, FL, USA
4Department of Dietetics and Nutrition, AHC-1-435, Robert Stempel College of Public Health and Social Work, 11200 S. W. 8th Street, Miami, FL 33199, USA
corresponding authorCorresponding author.
Joan A Vaccaro: jvaccaro/at/fiu.edu; Daniel J Feaster: DFeaster/at/biostat.med.miami.edu; Sandra L Lobar: lobars/at/fiu.edu; Marianna K Baum: baumm/at/fiu.edu; Marcia Magnus: magnus/at/fiu.edu; Fatma G Huffman: huffmanf/at/fiu.edu
Received July 11, 2011; Accepted March 12, 2012.
Abstract
Background
Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors.
Methods
We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design.
Results
Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats.
Conclusions
Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.
Keywords: Medical advice, Diabetes self-management, Mexican-American, Black non-Hispanic, Race/ethnicity, Minorities
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