Schillinger Dean, Hammer Hali, Wang Frances, Palacios Jorge, McLean Ivonne, Tang Audrey, Youmans Sharon, Handley Margaret
University of California, San Francisco Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA 94110, USA.
Health Educ Behav. 2008 Oct;35(5):664-82. doi: 10.1177/1090198106296772. Epub 2007 May 18.
The authors examined whether tailored self-management support (SMS) strategies reach patients in a safety net system and explored variation by language, literacy, and insurance. English-, Spanish-, and Cantonese-speaking diabetes patients were randomized to weekly automated telephone disease management (ATDM) or monthly group medical visits. The SMS programs employ distinct communication methods but share common objectives, including behavioral "action plans." Reach was measured using three complementary dimensions: (a) participation among clinics, clinicians, and patients; (b) patient representativeness; and (c) patient engagement with SMS. Participation rates were high across all levels and preferentially attracted Spanish-language speakers, uninsured, and Medicaid recipients. Although both programs engaged a significant proportion in action planning, ATDM yielded higher engagement, especially among those with limited English proficiency and limited literacy. These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities.
作者们研究了量身定制的自我管理支持（SMS）策略是否能惠及安全网系统中的患者，并探讨了语言、读写能力和保险方面的差异。将讲英语、西班牙语和粤语的糖尿病患者随机分为接受每周自动电话疾病管理（ATDM）或每月小组医疗问诊。SMS项目采用不同的沟通方式，但有共同目标，包括行为“行动计划”。通过三个互补维度衡量覆盖面：（a）诊所、临床医生和患者的参与度；（b）患者代表性；（c）患者对SMS的参与度。各级参与率都很高，且优先吸引讲西班牙语者、未参保者和医疗补助领取者。尽管两个项目都有很大比例的人参与行动计划，但ATDM的参与度更高，尤其是在英语水平有限和读写能力有限的人群中。这些结果为健康沟通和转化研究提供了重要见解，有助于实现SMS的公共卫生效益，并为减少健康差距的系统层面规划提供参考。
