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Study Suggests Need for Better Self-Management Education to Address Cultural Differences among Veterans with Diabetes


Among veterans receiving VA care, 20% are diagnosed with diabetes. Approximately 24% of these veterans are non-white, but more than half have risk factors for ulcers and amputations. Although non-white veterans have documented disparities in the quality of some diabetes care processes and intermediate outcome measures, racial disparities in foot care examinations have not been widely explored. This study examined differences in self-reported diabetes foot-care education, behaviors, and barriers to good foot care among veterans with diabetes by race and ethnicity. Investigators assessed self-report survey data for 728 veterans with diabetes who received care at any of eight VA medical centers in 2001.

Findings show that there are significant differences in self-reported foot care and education across racial and ethnic groups among veterans with diabetes. The majority of respondents felt that they did not know enough about foot self-care, with significant differences in behavior with regard to race and ethnicity. For example, whites and American Indian/Pacific Islanders generally felt they knew enough, but also had the highest rates of sub-optimal foot care self-management. Asian and American Indian/Pacific Islander veterans consistently identified a lack of education and resources as major barriers, and were far more likely than white veterans to feel they did not know enough on a given topic, indicating an opportunity for enhanced self-management education and care in these groups. Authors suggest the need for better self-management education to address culture, knowledge, preferences, and unique barriers to care.

Olson J, Hogan M, Pogach L, Rajan M, Raugi G, and Reiber G. Foot care education and behaviors in diverse veterans with diabetes. Patient Preference and Adherence 2009 Jan;3:45-50.

This study was funded by HSR&D. Drs. Hogan, Pogach, and Reiber are part of the VA/HSR&D Diabetes Mellitus Quality Enhancement Research Initiative (DM-QUERI).

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.