Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes

- Use of complementary health approaches is common by diverse patients with diabetes.
- Over half of patients disclosed use of complementary health approaches to providers.
- The most common reason for non-disclosure is that providers did not ask patients about use.
- Disclosure is associated with patient-physician language concordance.
- Disclosure is associated with physicians' use of a shared decision-making approach.

ObjectivePatient-provider communication about complementary health approaches can support diabetes self-management by minimizing risk and optimizing care. We sought to identify sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes.MethodsWe used data from San Francisco Health Plan's SMARTSteps Program, a trial of diabetes self-management support for low-income patients (n = 278) through multilingual automated telephone support. Interviews collected use and disclosure of complementary health approaches in the prior month, patient-physician language concordance, and quality of communication.ResultsAmong racially, linguistically diverse participants, half (47.8%) reported using complementary health practices (n = 133), of whom 55.3% disclosed use to providers. Age, sex, race/ethnicity, nativity, education, income, and health literacy were not associated with disclosure. In adjusted analyses, disclosure was associated with language concordance (AOR = 2.21, 95% CI: 1.05, 4.67), physicians' interpersonal communication scores (AOR = 1.50, 95% CI: 1.03, 2.19), shared decision making (AOR = 1.74, 95% CI: 1.33, 2.29), and explanatory-type communication (AOR = 1.46, 95% CI: 1.03, 2.09).ConclusionSafety net patients with diabetes commonly use complementary health approaches and disclose to providers with higher patient-rated quality of communication.Practice implicationsPatient-provider language concordance and patient-centered communication can facilitate disclosure of complementary health approaches.