Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study
Open accessAbstract
Background. Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. Aims. We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting. Method. We report a pre–post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool. Results. Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% “learned a lot,” 98% “topics relevant” 95% “applicable to their lives,” 98% “liked the information”). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p < .05) and pharmacists (13% to 25.5%, p < .01), not skipping doses of medicines due to cost (11% to 4%, p < .03), and financial management (33.83 to 39.62, p < .007). There were no significant changes in perception of financial burden. Conclusion. A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.
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Studies of referral-based interventions reported moderate increases in resource use (pooled SMD = 0.54, 95% CI, 0.31-0.78).
“and resource use (pooled SMD = 0.54, 95% CI, 0.31-0.78).”
From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [30]
The Results (Exploratory Health and Behavioral Outcomes; page unavailable) report increased use of some low-cost resources after this single pilot intervention. The paper does not report a pooled standardized mean difference or the stated 95% confidence interval; its Methods describe a one-group pre–post analysis, not a pooling of studies. (LLM, conf=0.88)
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- Authors
- Patel, M. R., Resnicow, K., Lang, I., Kraus, K., & Heisler, M.
- Affiliations
- University of Michigan (US)
- University of Michigan School of Public Health, Ann Arbor, MI, USA
- Corresponding author
- Patel, Minal R.
- Venue
- Health Education & Behavior
- Publisher
- SAGE Publications
- Published
- 2017-04-26
- Volume
- 45
- Issue
- 1
- Pages
- 101-111
- ISSN
- 1090-1981 (ISSN-L)
- 1552-6127
- PMC
- PMC5908467
- OpenAlex
- W2608983893
- Cited by
- 30
- References
- 6
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 4 · 2020: 4 · 2019: 3
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Education & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- cost-related nonadherence, diabetes mellitus, financial burden, prediabetes, medication adherence, behavioral interventions, patient-centered outcomes, social needs, financial management, treatment acceptability
- MeSH terms
- Diabetes Mellitus, Female, Financing, Personal, Humans, Male, Middle Aged, Patient Education as Topic, Pilot Projects, Surveys and Questionnaires, Prevalence, Cost of Illness, Disease Management, Medication Adherence, Self Report
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