Keys to successful diabetes self-management for uninsured patients: Social support, observational learning, and turning points: A safety net providers' strategic alliance study

Objective: To examine how medically uninsured patients who receive health care at federally qualified health centers and free clinics are able to successfully self-manage diabetes compared to patients who are less successful. Methods: Two distinct groups of patients with diabetes for 6 months or longer were enrolled: (1) successful, defined as those with glycated hemoglobin (HbA_1c) of 7% or less or a recent improvement of at least 2% (n = 17); and (2) unsuccessful, defined as patients with HbA_1c of at least 9% (n = 9) and without recent improvement. Patients were interviewed about enabling factors, motivators, resources, and bam'ers to diabetes self-management. Data from interviews, chart reviews, and clinician surveys were analyzed using qualitative methods and statistical techniques. Results: African Americans comprised 57.7% of the sample and whites 38.5% (N = 26). No significant differences were detected between successful and unsuccessful groups in age, race, education, or employment status. Clinicians rated unsuccessful patients as having more severe diabetes and significantly lower levels of control than successful patients. Compared to unsuccessful patients, successful patients more often reported having friends or family with diabetes, more frequently sought information about the disease, used evidence-based self-management strategies, held more accurate perceptions of their own diabetes control, and experienced "turning point" events that motivated increased efforts in disease management. Conclusions: Patients who successfully managed diabetes learned from diabetic family members and interpreted disease-related events as motivational turning points. It may be beneficial to incorporate social learning and motivational enhancement into diabetes interventions to increase patients' motivation for improved levels of self-management.