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Disclosure of Complementary Health Approaches among Low Income and Racially Diverse Safety Net Patients with Diabetes
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  • Description:

    Patient-provider communication about complementary health approaches can support diabetes self-management by minimizing risk and optimizing care. We sought to identify sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes.


    We used data from San Francisco Health Plan's SMARTSteps Program, a trial of diabetes self-management support for low-income patients (n=278) through multilingual automated telephone support. Interviews collected use and disclosure of complementary health approaches in the prior month, patient-physician language concordance, and quality of communication.


    Among racially, linguistically diverse participants, half (47.8%) reported using complementary health practices (n=133), of whom 55.3% disclosed use to providers. Age, sex, race/ethnicity, nativity, education, income, and health literacy were not associated with disclosure. In adjusted analyses, disclosure was associated with language concordance (AOR=2.21, 95% CI: 1.05, 4.67), physicians' interpersonal communication scores (AOR=1.50, 95% CI: 1.03, 2.19), shared decision making (AOR=1.74, 95% CI: 1.33, 2.29), and explanatory-type communication (AOR = 1.46, 95% CI: 1.03, 2.09).


    Safety net patients with diabetes commonly use complementary health approaches and disclose to providers with higher patient-rated quality of communication.

    Practice Implications

    Patient-provider language concordance and patient-centered communication can facilitate disclosure of complementary health approaches.

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  • Funding:
    P30 DK063720/DK/NIDDK NIH HHS/United States
    KL2 TR000143/TR/NCATS NIH HHS/United States
    K01AT006545/AT/NCCIH NIH HHS/United States
    R03HS020684/HS/AHRQ HHS/United States
    1P30-DK092924/DK/NIDDK NIH HHS/United States
    K01 AT006545/AT/NCCIH NIH HHS/United States
    P30 DK092924/DK/NIDDK NIH HHS/United States
    R18HS017261/HS/AHRQ HHS/United States
    UL1 RR024131,/RR/NCRR NIH HHS/United States
    KL2TR00143/TR/NCATS NIH HHS/United States
    K08 HS022561/HS/AHRQ HHS/United States
    5U58DP002007-03/DP/NCCDPHP CDC HHS/United States
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