Journal of General Internal Medicine

, Volume 17, Issue 4, pp 243–252 | Cite as

The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management

  • Michele HeislerEmail author
  • Reynard R. Bouknight
  • Rodney A. Hayward
  • Dylan M. Smith
  • Eve A. Kerr
Original Articles


OBJECTIVE: Patients’ self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles on patients’ diabetes self-management. This study assessed the influence of patients’ evaluation of their physicians’ participatory decision-making style, rating of physician communication, and reported understanding of diabetes self-care on their self-reported diabetes management.

DESIGN: We surveyed 2,000 patients receiving diabetes care across 25 Veterans’ Affairs facilities. We measured patients’ evaluation of provider participatory decision making with a 4-item scale (Provider Participatory Decision-making Style [PDMstyle]; α=0.96), rating of providers’ communication with a 5-item scale (Provider Communication [PCOM]; α=0.93), understanding of diabetes self-care with an 8-item scale (α=0.90), and patients’ completion of diabetes self-care activities (self-management) in 5 domains (α=0.68). Using multivariable linear regression, we examined self-management with the independent associations of PDMstyle, PCOM, and Understanding.

RESULTS: Sixty-six percent of the sample completed the surveys (N=1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self-management assessments (P<.01 in all models). When modeled together, PCOM remained a significant independent predictor of self-management (standardized β: 0.18; P<.001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized β: 0.10; P=.004). Understanding was strongly and independently associated with self-management (standardized β: 0.25; P<.001).

CONCLUSION: For these patients, ratings of providers’ communication effectiveness were more important than a participatory decision-making style in predicting diabetes self-management. Reported understanding of self-care behaviors was highly predictive of and attenuated the effect of both PDMstyle and PCOM on self-management, raising the possibility that both provider styles enhance self-management through increased patient understanding or self-confidence.

Key words

physician-patient relations disease management self-care ambulatory care chronic disease 


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Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Michele Heisler
    • 1
    • 2
    Email author
  • Reynard R. Bouknight
    • 5
  • Rodney A. Hayward
    • 1
    • 2
    • 3
    • 4
  • Dylan M. Smith
    • 1
  • Eve A. Kerr
    • 1
    • 2
  1. 1.the Veterans Affairs Center for Practice Management and Outcomes ResearchVA Ann Arbor Healthcare SystemAnn Arbor
  2. 2.The Robert Wood Johnson Clinical Scholars ProgramUniversity of Michigan School of MedicineAnn Arbor
  3. 3.Department of Internal MedicineUniversity of Michigan School of MedicineAnn Arbor
  4. 4.Michigan Diabetes Research and Training CenterUniversity of Michigan School of MedicineAnn Arbor
  5. 5.the College of Human MedicineMichigan State UniversityEast Lansing

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