Diabetes Care
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Diabetes Care 29:1249-1255, 2006
DOI: 10.2337/dc05-2494
© 2006 by the American Diabetes Association
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Epidemiology/Health Services/Psychosocial Research
Original Article

Health Care and Patient-Reported Outcomes

Results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study

Richard R. Rubin, PHD1,2, Mark Peyrot, PHD1,3, Linda M. Siminerio, PHD, RN4 on behalf of the International DAWN Advisory Panel*

1 Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
2 Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
3 Department of Sociology, Loyola College
4 University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania

Address correspondence and reprint requests to Richard R. Rubin, PhD, 946 East Piney Hill Rd., Monkton, MD 21111. E-mail: rrubin443{at}aol.com

OBJECTIVE—The purpose of this study was to assess the relationship of patients’ self-reported well-being, self-management, and diabetes control with factors related to the patient’s health care.

RESEARCH DESIGN AND METHODS—This was a cross-sectional survey of national samples of patients with diabetes (n = 5,104) from the multinational study of Diabetes Attitudes, Wishes and Needs (DAWN). Patients from 13 countries in Asia, Australia, Europe, and North America reported their level of well-being, self-management, and diabetes control. Hierarchical multiple regression analysis (blocks are countries, respondent characteristics, and health care features) was used to examine predictors of diabetes-related distress and general well-being, adherence to lifestyle and medical treatment recommendations, and perceived diabetes control and hyperglycemic symptoms.

RESULTS—Country, respondent demographic and disease characteristics, and health care features were all associated with patient-reported outcomes. Better patient-provider collaboration was associated with more favorable ratings on all outcomes, and better access to the provider and availability of team care were associated with some positive outcomes. Country differences were only partly accounted for by patient and health care factors. Relationships between health care factors and outcomes varied across countries.

CONCLUSIONS—Patients’ reports of well-being, self-management, and diabetes control were related to the countries in which they live, their demographic and disease characteristics, and features of their health care. Opportunities to enhance patient-provider collaboration, access to care, and availability of team care should be pursued.

Abbreviations: DAWN, Diabetes Attitudes, Wishes and Needs


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Copyright © 2006 by the American Diabetes Association.