Utilizing English and Spanish Multimodal Low Literacy Diabetes Self-Management Education to Improve Diabetes Knowledge: A Quality Improvement Project in a Low-Cost Clinic

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Stinson, Kamasha
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Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Caring sciences::Nursing , Diabetes Mellitus, Type 2 , Quality Improvement , Health Promotion , Adults , Health Literacy , Self Efficacy
Background: Health literacy is a vital competence when working toward successful management of Type II Diabetes (T2D). The ability to understand, assess, and apply health information in order to make judgements and decisions every day to maintain or improve quality of life is important. Sufficient health literacy is linked to an individual’s knowledge, motivation, and self-efficacy resulting in better health conditions and self-efficacy in people with T2D (Finbraten et al., 2020). Objective: This quality improvement project aimed at initiating health literacy screenings and utilizing English and Spanish multimodal low literacy diabetes self-management education (DSME) to increase diabetes knowledge in adult patients with T2D. Methods: A Registered Dietitian health educator in the health and wellness program of a community health center administered the Brief Health Literacy Screening (BHLS) and a pre-intervention Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD) to 20 adult patients with T2D to screen literacy levels and diabetes knowledge prior to their DSME session. The DSME was then offered in English and Spanish with low literacy handouts and audiovisual videos. A post-intervention SKILLD survey was conducted one week after the DSME to test the association between low health literacy DSME and diabetes knowledge. Results: Thirty-four patients signed up to participate in the DSME group session, but only twenty-four patients attended the low literacy screening and low literacy DSME session. The BHLS screening indicated that 41.7 % of the participants had adequate health literacy, 37.5 % had moderate health literacy, and 20.8 % had limited health literacy. A two-tailed sample t-test was conducted to examine whether the mean difference of the pre-intervention SKILLD survey and the post intervention SKILLD survey were significantly impacted by the language specific low literacy DSME session. An alpha value of .05, t(23) = -4.10, p < .001 revealed that low literacy DSME educational handouts and audiovisual videos significantly improved diabetes knowledge in the participants of this intervention. Conclusion: The primary outcome of administering health literacy screenings on patients with T2D was successful. Evidence of limited health literacy and diabetes knowledge were noted in several participants prior to the DSME session. The post-intervention SKILLD survey revealed significant improvements in diabetes knowledge with the utilization of language specific multimodal low-literacy DSME.