Assessment of Diabetes Attitudes, Wishes, and Needs Among Insured and Uninsured Rural Adults

Diabetes is a complex chronic disease primarily managed by the person with diabetes. Patient involvement in decision-making regarding treatment is associated with better clinical outcomes. A study conducted in 2001 described the Diabetes Attitudes, Wishes and Needs (DAWN) of people with diabetes (N=5014) and of the health care providers who treat people with diabetes (N=3827), and demonstrated better clinical outcomes and quality of life when care providers knew the "DAWN" elements affecting their patients. One of the limitations of the DAWN studies includes sample characteristics --patients and health care providers were primarily from urban areas, and there was no discussion of patients without insurance. Thus, there are few published studies about the attitudes, wishes and needs of people living in rural areas and those with no insurance. This study involved two groups of adults with type 2 diabetes: (1) 20 uninsured participants who attended a free clinic; and (2) 25 participants who received care for their diabetes at an endocrinology clinic associated with a large university medical center. Participants completed a questionnaire to report diabetes attitudes, wishes, and needs. Findings indicate that the biggest concerns these two groups have in regards to caring for their diabetes are diet and control of diabetes in general. When asked about thoughts or feelings related to caring for diabetes, participants responded with "worried" or "hopeful" the majority of the time. Participants also evaluated the use of the questionnaire; at least two thirds of participants felt the form made discussing their concerns about diabetes easier during the appointment, and that their health care provider understood their 3 concerns well. Two thirds of the study participants did not feel using the form made their appointments any longer, and half stated they would like to use the form for every appointment. Findings from this study will enhance the ability of clinicians to effectively tailor the delivery of diabetes care to the needs of rural adults with and without health insurance.

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