Addressing Literacy and Numeracy to Improve Diabetes Care: Two Randomized Controlled Trials
- Kerri Cavanaugh, MD MHS1,2,
- Kenneth A. Wallston, PhD3,
- Tebeb Gebretsadik, MPH4,
- Ayumi Shintani, PhD MPH4,
- Mary Margaret Huizinga, MD MPH5,
- Dianne Davis, RD CDE2,
- Rebecca Pratt Gregory, RD CDE2,
- Robb Malone, PharmD CDE6,7,
- Michael Pignone, MD MPH6,
- Darren DeWalt, MD MPH6,
- Tom A. Elasy, MD MPH2,8 and
- Russell L. Rothman, MD MPP (russell.rothman{at}vanderbilt.edu)2,8,9
- 1 Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- 2 Vanderbilt Eskind Diabetes Center, Diabetes Research & Training Center, Vanderbilt University, School of Medicine, Nashville, TN
- 3 School of Nursing, Vanderbilt University Medical Center, Nashville, TN
- 4 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
- 5 Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- 6 Department of Medicine, University of North Carolina, Chapel Hill, NC
- 7 Division of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC
- 8 VA Tennessee Valley Healthcare System, VA Quality Scholars Program, Nashville, TN
- 9 Division of General Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
Abstract
Objective: Diabetes patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy and numeracy-sensitive diabetes care within an enhanced diabetes care program on A1C and other diabetes outcomes.
Research Design and Methods: In two randomized controlled trials, we enrolled 198 adult diabetes patients with most recent A1C ≥ 7.0%, referred for participation in an enhanced diabetes care program. For 3 months, control patients received care from existing enhanced diabetes care programs, while intervention patients received enhanced programs that also addressed literacy and numeracy at each institution. Intervention providers received health communication training, and used the interactive Diabetes Literacy and Numeracy Education Toolkit (DLNET) with patients. A1C was measured at 3 and 6 months follow-up. Secondary outcomes included self-efficacy, self-management behaviors, and treatment satisfaction.
Results: At 3 months, both intervention and control patients had significant improvements in A1C from baseline (Intervention: −1.50 [95% CI: −1.80, −1.02]; Control: −0.80 [95% CI: −1.10, −0.30]). In adjusted analysis, there was greater improvement in A1C in the intervention group compared to the control group (p=0.03). At 6 months, there were no differences in A1C between intervention and control groups. Self-efficacy improved from baseline for both groups. No significant differences were found for self-management behaviors or satisfaction.
Conclusions: A literacy and numeracy focused diabetes care program modestly improved self-efficacy and glycemic control compared to standard enhanced diabetes care, but the difference attenuated after conclusion of the intervention.
Footnotes
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- Received March 23, 2009.
- Accepted August 31, 2009.
