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

Ng, Carmen Stephanie (2015)
Master's Thesis (56 pages)
Committee Chair / Thesis Adviser: Lipscomb, Joseph
Committee Members: Gaydos, Laurie ; Rask, Kimberly J ; Jacobson, Kara L
Research Fields: Health Sciences, Public Health; Health Sciences, Health Care Management
Partnering Agencies: Emory University schools, faculty or affiliated programs ; University, college or educational institution (other than Emory)
Keywords: limited English proficiency; diabetes; self-efficacy
Program: Rollins School of Public Health, Health Policy and Management
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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

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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