Abstract
Background
Despite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited.
Objective
To describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education.
Design
Materials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design.
Participants
Pilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (n = 15) and Average literacy (n = 15).
Measurements
Wide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale.
Results
Reading grade levels were: >12th, 30%; 10th–12th, 20%; 7th–9th, 10%; 4th–6th grade, 10%; and ≤3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of ≤4th grade. Knowledge improved for Below Average (2.7 to 4.7, p = 0.005) and Average (3.8 to 5.7, p = 0.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients.
Conclusions
Development of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level.
This is a preview of subscription content, log in via an institution to check access.
References
Kutner M, Greenberg E, Jin Y, Boyle B, Hsu Y, Dunleavy E. Literacy in Everyday Life: Results from the 2003 National Assessment of Adult LiteracyNCES 2007-480. Washington, DC: National Center for Education Statistics, U.S. Dept. of Education; 2007.
Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Survey of Adult LiteracyNCES 2006-483. Washington, DC: National Center for Education Statistics, U.S. Dept. of Education; 2006.
Institute of Medicine. Health Literacy - A Prescription to End Confusion. Nielsen-Bohlman L, Panzer AM, and Kindig DA. Washington, DC: National Academies Press; 2004.
Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L et al. Literacy and health outcomes. Evid Rep Technol Assess (Summ). 2004;1–8.
Marcus EN. The silent epidemic-the health effects of illiteracy. N Engl J Med. 2006;355:339–41.
Hill-Briggs F, Smith AS. Evaluation of diabetes and cardiovascular disease print patient education materials for use with low health literate populations. Diabetes Care. 2008;31:1–5.
American Diabetes Association. Standards of medical care in diabetes-2006Diabetes Care. 2006;29(Suppl 1):S4–S42.
Funnell MM, Arnold MS, Lasichak A, Barr PA. Type 2 diabetes: a curriculum for patients and health professionals. Alexandria, VA: American Diabetes Association; 2002.
Centers for Disease Control and Prevention. Scientific and Technical Information Simply Put, 2nd ed. Atlanta: Office of Communication, Centers for Disease Control and Prevention; 1999.
Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills, 2nd ed. Philadelphia, PA: J.B. Lippincott Company; 1996.
National Cancer Institute. Clear and Simple: Developing Effective Print Materials for Low-Literate Readers. Bethesda, MD: U.S. Department of Health and Human Services; 1994.
Williams AS. Accessible diabetes education materials in low-vision format. Diabetes Educ. 1999;25:695–8. 700, 702.
American Diabetes Association. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association; 2002.
Gary TL, Batts-Turner M, Bone LR, Yeh HC, Wang NY, Hill-Briggs F, et al. A Randomized Controlled Trial of the Effects of Nurse Case Manager and Community Health Worker Team Interventions in Urban African-Americans with Type 2 Diabetes. Control Clin Trials. 2004;25:53–66.
Wilkinson GS. Wide Range Achievement Test Administration Manual. Wilmington, DE: Wide Range, Inc.; 1993.
Mensing C, Boucher J, Cypress M, Weinger K, Mulcahy K, Barta P, et al. National standards for diabetes self-management education. Diabetes Care. 2006;29(Suppl 1):S78–S85.
Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.
Hill-Briggs F. Problem solving in diabetes self-management: a model of chronic illness self-management behavior. Ann Behav Med. 2003;25:182–93.
Acknowledgments
This research was funded by National Institutes of Health grant K01HL076644, American Diabetes Association grant 7-06-IN-07, and the Johns Hopkins University School of Medicine General Clinical Research Center grant M01-RR00052 from the National Center for Research Resources/NIH. It was presented in part at the Society of Behavioral Medicine, Washington D.C., March 2007. We thank Joy Mays for technical assistance in the preparation of this manuscript.
Conflicts of Interest
Drs. Hill-Briggs, Lazo, Bone, Hill, Levine and Brancati, and Ms. Renosky report no conflicts of interest. Dr. Peyrot’s dualities of interest include consulting arrangements with Amylin, Animas, MannKind, Medingo, Medtronic, and Novo Nordisk; honoraria provided by Novo Nordisk; research grants funded by Amylin, MannKind, Medtronic, and Novo Nordisk; and pending research grants through MannKind, Medtronic, and Novo Nordisk. The research described in this manuscript is not related to Dr. Peyrot’s relationships with these companies.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hill-Briggs, F., Renosky, R., Lazo, M. et al. Development and Pilot Evaluation of Literacy-Adapted Diabetes and CVD Education in Urban, Diabetic African Americans. J GEN INTERN MED 23, 1491–1494 (2008). https://doi.org/10.1007/s11606-008-0679-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0679-9