Original Articles

Journal of General Internal Medicine

, Volume 18, Issue 8, pp 624-633

First online:

Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population

  • John D. PietteAffiliated withthe Department of Internal Medicine, University of MichiganCenter for Practice Management and Outcomes Research, VA Ann Arbor Health Care System Email author 
  • , Dean SchillingerAffiliated withthe Primary Care Research Center, San Francisco General Hospital, University of California-San Francisco
  • , Michael B. PotterAffiliated withthe Department of Family and Community Medicine, University of California-San Francisco
  • , Michele HeislerAffiliated withthe Department of Internal Medicine, University of MichiganCenter for Practice Management and Outcomes Research, VA Ann Arbor Health Care System

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BACKGROUND: Patient-provider communication is essential for effective care of diabetes and other chronic illnesses. However, the relative impact of general versus disease-specific communication on self-management is poorly understood, as are the determinants of these 2 communication dimensions.

DESIGN: Cross-sectional survey.

SETTING: Three VA heath care systems, 1 county health care system, and 1 university-based health care system.

PATIENTS: Seven hundred fifty-two diabetes patients were enrolled. Fifty-two percent were nonwhite, 18% had less than a high-school education, and 8% were primarily Spanish-speaking.

MEASUREMENTS AND MAIN RESULTS: Patients’ assessments of providers’ general and diabetes-specific communication were measured using validated scales. Self-reported foot care; and adherence to hypoglycemic medications, dietary recommendations, and exercise were measured using standard items. General and diabetes-specific communication reports were only moderately correlated (r=.35) and had differing predictors. In multivariate probit analyses, both dimensions of communication were independently associated with self-care in each of the 4 areas examined. Sociodemographically vulnerable patients (racial and language minorities and those with less education) reported communication that was as good or better than that reported by other patients. Patients receiving most of their diabetes care from their primary provider and patients with a longer primary care relationship reported better general communication. VA and county clinic patients reported better diabetes-specific communication than did university clinic patients.

CONCLUSIONS: General and diabetes-specific communication are related but unique facets of patient-provider interactions, and improving either one may improve self-management. Providers in these sites are communicating successfully with vulnerable patients. These findings reinforce the potential importance of continuity and differences among VA, county, and university health care systems as determinants of patient-provider communication.

Key Words

diabetes mellitus self-care communication barriers access to care chronic disease management quality of care