Influence of perceived health provider communication, diabetes duration and age at diagnosis with confidence in diabetes self-care

Discussion

This study found that patients diagnosed at older ages have less confidence in managing their diabetes than patients diagnosed at younger ages. Correspondingly, a longer diabetes duration also leads to greater confidence in diabetes self-care. In addition, greater perceived healthcare provider communication resulted in greater confidence in diabetes self-care. These results were unchanged when adjusted for perceived healthcare communication and either age at diabetes diagnosis or diabetes duration, indicating that diabetes duration and perception of healthcare provider communication are independent predictors of confidence in diabetes self-care, since, if they were dependent on one another, the effect estimates would differ on adjusting for both factors.

Previous research has shown that younger, rather than older age at diabetes diagnosis, was associated with higher risk of mortality and vascular disease.24 In this study, diagnosis at older age was associated with less confidence in performing diabetes self-care activities than their younger counterparts. Perhaps this is because as age increases, patients are more likely to encounter barriers to self-care, including age-related physical limitations, a smaller social network, cognitive decline, multiple medical conditions and financial constraints that may decrease confidence.3 In addition, older adults also have geriatric syndromes such as urinary incontinence, chronic pains, falls, frailty and coexisting illnesses that can affect self-care if not addressed in combination with their diabetes diagnosis.3

Research has shown that a diabetes duration of less than 10 years is associated with low confidence in diabetes self-care.20 In this study, we found that diabetes duration was associated with having greater confidence in performing diabetes self-care activities. This finding seems reasonable since the earlier patients are diagnosed, the more time they can master self-care. However, literature shows that a longer diabetes duration leads to more diabetic complications including retinopathy, neuropathy, chronic kidney disease and carotid artery plaque,3 20 suggesting that confidence would decline with these complications. Future studies should aim to examine factors that may impact confidence in self-care based on diabetes duration to further delineate these findings.

It was hypothesized that greater perceived healthcare provider communication would result in greater confidence in performing diabetes self-care activities. There is a body of literature that indicates perceived health provider communication has a substantial effect on self-care.8–16 This suggests that patients’ confidence in self-care should increase when positive provider communication is perceived. When examining the domains of perceived healthcare provider communication with confidence in diabetes, each domain was positively associated with confidence in performing diabetes self-care activities. However, when adjusting for all four domains, having healthcare providers clearly explain things to patients was the largest driver in increasing adherence to diabetes self-care activities. This is consistent with the literature on perceived patient–provider communication in which patients perceive the communication with their physicians more positively when their physicians take the time to make sure they understand the information provided to them regarding their diagnosis.10–12 17 18 In addition, the percentages of participants reporting ‘never’ or ‘sometimes’ were relatively low across all four questions, suggesting that most patients generally had positive experiences with their health providers’ communication skills. These findings indicate the need for interventions aimed at aiding better patient-physician communication for older adults who are newly diagnosed with diabetes.

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