Investing time in health: Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?

Susan L. Ettner, Betsy L. Cadwell, Louise B. Russell, Arleen Brown, Andrew J. Karter, Monika Safford, Carol M. Mangione, Gloria Beckles, William H. Herman, Theodore J. Thompson, David Marrero, Ronald T. Ackermann, Susanna R. Williams, Matthew J. Bair, Ed Brizendine, Aaro E. Carroll, Gilbert C. Liu, Paris Roach, Usha Subramanian, Honghong ZhouJoseph V. Selby, Bix E. Swain, Assiamira Ferrara, John Hsu, Julie A. Schmittdiel, Connie Uratsu, David J. Curb, Beth Waitzfelder, Rosina Everitte, Thomas Vogt, Richard Chung, Adams Dudley, Chien Wen Tseng, Qimei He, Xinli Li, Ruth Baldino, Elaine Quiter, Kendrik Duru, Shaista Malik, Martin F. Shapiro, Neil Steers, Norman Turk, Lisa Chan, Glenda Ventura, Norman L. Lasser, Stephen H. Schneider, Dorothy A. Caputo, Jesse C. Crosson, Stephen Crystal, Monica Girotra, David S. Kountz, Leslie Faith Taub Morritt, Shou En Lu, Pin Wen Wang, Gabrielle J. Davis, Lucyna Lis, Sonja Ross, William Marrone, Jennifer Goewey, Michele Heisler, Catherine Kim, Joyce Lee, Kingsley Onyemere, Aruna Sarma, Ray Burke, Laura McEwen, Rebecca Niehus, Edward W. Gregg, Bernice Moore, James P. Boyle, Tiffany Gary, Linda Geiss, Bob Gerzoff, Roberta H. Hilsdon, Henry Kahn, Venkat Narayan, Jinan Saaddine, Mark R. Stevens, Ted Thompson, Ed Tierney, Ping Zhang, Rui Li, Brenda Colley Gilbert, Millie Trotter, Shay Clayton, Larry Weller, Dori Bilik, Sanford A. Garfield, Eve Kerr, Rodney Hayward, Sarah Krein, John Piette, Mary Hogan, Fatima Makki

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

Original languageEnglish (US)
Pages (from-to)645-663
Number of pages19
JournalHealth Economics (United Kingdom)
Issue number6
StatePublished - 2009
Externally publishedYes


  • Diabetes
  • Disparities
  • Opportunity costs of time
  • Self-care
  • Socioeconomic status

ASJC Scopus subject areas

  • Health Policy

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