Implementation and Evaluation of a Low-Literacy Diabetes Education Computer Multimedia Application

Abstract

OBJECTIVE -To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population.RESEARCH DESIGN AND METHODS -Five public clinics in Chicago, Illinois, participated in the study with computer kiosks installed in waiting room areas. Two hundred forty-four subjects with diabetes were randomized to receive either supplemental computer multimedia use (intervention) or standard of care only (control). The intervention includes audio/video sequences to communicate information, provide psychological support, and promote diabetes self-management skills without extensive text or complex navigation. HbA 1c (A1C), BMI, blood pressure, diabetes knowledge, self-efficacy, self-reported medical care, and perceived susceptibility of complications were evaluated at baseline and 1 year. Computer usage patterns and implementation barriers were also examined.RESULTS -Complete 1-year data were available for 183 subjects (75%). Overall, there were no significant differences in change in A1C, weight, blood pressure, knowledge, self-efficacy, or self-reported medical care between intervention and control groups. However, there was an increase in perceived susceptibility to diabetes complications in the intervention group. This effect was greatest among subjects with lower health literacy. Within the intervention group, time spent on the computer was greater for subjects with higher health literacy.CONCLUSIONS -Access to multimedia lessons resulted in an increase in perceived susceptibility to diabetes complications, particularly in subjects with lower health literacy. Despite measures to improve informational access for individuals with lower health literacy, there was relatively less use of the computer among these participants. Diabetes Care 28:1574 -1580, 2005T here is a growing awareness of the impact of low health literacy on diabetes (1,2). Low health literacy poses a major barrier to education and self-management (3). Health literacy directly impacts health outcomes, such as hospitalization risk, particularly in those with chronic diseases (4,5). In one crosssectional study (5) measuring the health literacy level of type 2 diabetic patients, patients with inadequate health literacy were less likely than those with adequate health literacy to achieve tight glycemic control. However, there is limited data from longitudinal studies regarding the impact of health literacy on changes in clinical outcomes over time (2).Despite increasing concern about the impact of low health literacy on diabetes care, there are few proven interventions available that address low health literacy (6). Recent evidence (6,7) suggests that diabetes education improves selfmanagement and glycemic control in those with limited health literacy. Simultaneously, clinicians are faced with less time and resources for disseminating information. Regular attendance in diabetes education classes is disappointingly low, particularly for those with lower socioeconomic status and those who...

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