Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Complementary and alternative medicine; Complementary health approaches; Diabetes; Disclosure; Health communication; Health disparities; Integrative medicine; Limited English proficiency.