RESEARCH ARTICLE


Educational Attainment is Associated with Health Care Utilization and Self-Care Behavior by Individuals with Diabetes



Abdullah Alguwaihes1, Baiju R. Shah1, 2, 3, *
1 Department of Medicine, University of Toronto, Toronto, ON, Canada.
2 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
3 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.


© 2009 Alguwaihes et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Institute for Clinical Evaluative Sciences, G106 - 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. Tel: 416 480 4706; Fax: 416 480 6048; E-mail : baiju.shah@ices.on.ca


Abstract

The aim of this study was to examine the association between educational attainment and utilization of the health care system and self-care behavior by individuals with diabetes. The Barriers to Diabetes Care Survey asked individuals with diabetes about their care. The questionnaire was completed using computer-assisted telephone interviewing techniques. Participants were found by random digit dialing across Ontario, Canada (eligible n = 1,031). We dichotomized educational attainment at high school. We examined the relationship of educational attainment with measures of health care system utilization and of self-care behavior. We adjusted for age, sex, income, health insurance status, and diabetes type, duration and treatment regimen. Individuals with high educational attainment were more likely to have had an ophthalmologic examination during the previous year (odds ratio 1.37, 95% confidence interval 1.04-1.82), and were more likely to report having a specialist (OR 2.08, 95% CI 1.31-3.31) or other paramedical professional (OR 1.91, 95% CI 1.19-3.07) as their most responsible provider of care, rather than a family doctor. Smoking (OR 0.64, 95% CI 0.45-0.90) and blood sugar monitoring (OR 0.70, 95% CI 0.50-0.98) were associated with low educational attainment, while following a meal plan was associated with high educational attainment (OR 1.39, 95% CI 1.07-1.80). Since appropriate utilization of the health care system and self-care behavior are essential for diabetes management, our findings suggest that people with low educational attainment are independently at risk for worse diabetes care. Health care providers should ensure that their communications, teaching materials and instructions are suitable for these higher-risk patients.

Keywords: Educational attainment, health care system utilization, self-care behavior.