Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting

Patient Educ Couns. 2015 Feb;98(2):144-9. doi: 10.1016/j.pec.2014.10.019. Epub 2014 Oct 28.


Objective: Diabetes patients with limited resources often experience suboptimal care. Less is known about the role of effective health communication (HC) in caring for low income diabetes patients.

Methods: Ten health department clinics in TN participated in a trial evaluating a literacy-sensitive communication intervention. We assessed the quality of baseline HC and measured associations with diabetes outcomes. Assessments included: demographics, measures of HC, health literacy, self-care behaviors, self-efficacy, medication non-adherence, treatment satisfaction, and A1C. Unadjusted and adjusted multivariable regression models were used to test associations.

Results: Participants (N=411) were 49.7±9.5 years, 61% female, uninsured (96%), with A1C 9.6±2.1. In unadjusted analyses, better communication, was associated with lower medication non-adherence (OR 0.40-0.68, all p<0.05), higher treatment satisfaction (OR 1.76-1.96, all p<0.01), portion size reduction (OR 1.43, p<0.05), diabetes self-efficacy (OR 1.41, p<0.05), and lower A1C (β=-0.06, p<0.01). In adjusted analyses, communication quality remained associated with lower medication non-adherence (AOR 0.39-0.68, all p<0.05), and higher treatment satisfaction (AOR 1.90-2.21, all p<0.001).

Conclusions: Better communication between low-income patients and providers was independently associated with lower medication non-adherence and higher treatment satisfaction.

Practice implications: Communication quality may be an important modifiable approach to improving diabetes care for vulnerable populations.

Keywords: Diabetes; Health communication; Primary care; Provider education; Public health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Diabetes Mellitus, Type 2 / psychology*
  • Diabetes Mellitus, Type 2 / therapy
  • Female
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism
  • Health Communication*
  • Health Knowledge, Attitudes, Practice
  • Health Literacy*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Personal Satisfaction*
  • Poverty* / psychology
  • Self Care*
  • Self Efficacy
  • Tennessee
  • Treatment Outcome


  • Glycated Hemoglobin A
  • Hypoglycemic Agents