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Potential Effect of Vouchers on the Completion of Self-management Education Among Patients With Diabetes

Lyonnais, Mary Jane MPH; Bray, Paul MA, LMFT; Rafferty, Ann P. PhD; Winterbauer, Nancy L. PhD, MA, MS; Bell, Ronny A. PhD, MS

Journal of Public Health Management and Practice: February 22, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000985
Research Brief Report: PDF Only

Diabetes is a significant public health problem in eastern North Carolina, and completion of formal diabetes self-management education (DSME) is low. To seek methods to increase DSME completion, patients with diabetes in an eastern North Carolina regional health care system who had not completed DSME (n = 58) were surveyed during wellness visits to examine attitudes toward the use of vouchers (eg, coupons that purchase healthy food, exercise classes, gym memberships). There was an extremely low awareness (19%) of and referral (5%) to DSME. Most respondents (77%) said they would or might be more likely to complete DSME if they received a voucher at the end. Vouchers for healthy food venues such as farmers' markets were most preferred, and 6 months or less was found to be an acceptable time frame to use the voucher. This study offers some evidence for DSME providers to explore vouchers as one approach to increase program completion.

Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina (Ms Lyonnais and Drs Rafferty, Winterbauer, and Bell); and Vidant Health, Greenville, North Carolina (Mr Bray). Ms Lyonnais is now with Albemarle Regional Health Services, Elizabeth City, North Carolina.

Correspondence: Ann P. Rafferty, PhD, Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Dr, MS 660, Greenville, NC 27834 (

These results were presented by Mary Jane Lyonnais in a professional paper oral presentation (April 2017) as part of her MPH program.

The authors thank Sara Stevens for her help in manuscript preparation.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

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