Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program.

CONTEXT Low literacy is an important barrier for patients with diabetes, but interventions to address low literacy have not been well examined. OBJECTIVE To examine the role of literacy on the effectiveness of a comprehensive disease management program for patients with diabetes. DESIGN, SETTING, AND PARTICIPANTS Analysis of the influence of literacy on glycemic control and systolic blood pressure using data from a randomized controlled trial (conducted from February 2001 through April 2003) of a comprehensive diabetes management program. Participants were 217 patients aged 18 years or older with type 2 diabetes and poor glycemic control (glycosylated hemoglobin [HbA1c] levels > or =8.0%) and presenting to a US academic general internal medicine practice. INTERVENTIONS All communication to patients was individualized and delivered to enhance comprehension among patients with low literacy. Intervention patients received intensive disease management from a multidisciplinary team. Control patients received an initial management session and continued with usual care. MAIN OUTCOME MEASURES Achievement of goal HbA1c levels and systolic blood pressure at 12-month follow-up for control and intervention patients stratified by literacy status. RESULTS Complete 12-month data were available for 193 patients (89%). Among patients with low literacy, intervention patients were more likely than control patients to achieve goal HbA1c levels (< or =7.0%) (42% vs 15%, respectively; adjusted odds ratio [OR], 4.6; 95% confidence interval [CI], 1.3 to 17.2; P = .02). Patients with higher literacy had similar odds of achieving goal HbA1c levels regardless of intervention status (24% vs 23%; adjusted OR, 1.0; 95% CI, 0.4 to 2.5; P = .98). Improvements in systolic blood pressure were similar by literacy status. CONCLUSIONS Literacy may be an important factor for predicting who will benefit from an intervention for diabetes management. A diabetes disease management program that addresses literacy may be particularly beneficial for patients with low literacy, and increasing access to such a program could help reduce health disparities.

[1]  R. Dittus,et al.  A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. , 2005, The American journal of medicine.

[2]  R. Hayward,et al.  Case management for patients with poorly controlled diabetes: a randomized trial. , 2004, The American journal of medicine.

[3]  D. DeWalt,et al.  The Relationship Between Literacy and Glycemic Control in a Diabetes Disease-Management Program , 2004, The Diabetes educator.

[4]  David A. Kindig,et al.  Health literacy : a prescription to end confusion , 2004 .

[5]  D. Schillinger,et al.  Closing the loop: physician communication with diabetic patients who have low health literacy. , 2003, Archives of internal medicine.

[6]  Tabitha Zimmerman,et al.  Health literacy and diabetic control. , 2002, JAMA.

[7]  D. Schillinger,et al.  Association of health literacy with diabetes outcomes. , 2002, JAMA.

[8]  S. Reder,et al.  Building a Level Playing Field: The Need To Expand and Improve the National and State Adult Education and Literacy Systems. NCSALL Occasional Paper. , 2001 .

[9]  W. Assendelft,et al.  Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. , 2001, Diabetes care.

[10]  J. Piette,et al.  Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes? , 2000, The American journal of medicine.

[11]  K. Hawthorne,et al.  Pakistani moslems with Type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self‐monitoring management and glycaemic control , 1999, Diabetic medicine : a journal of the British Diabetic Association.

[12]  D W Baker,et al.  Health literacy among Medicare enrollees in a managed care organization. , 1999, JAMA.

[13]  Khan Mk,et al.  Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. , 1999, JAMA.

[14]  D. Baker,et al.  Inadequate literacy is a barrier to asthma knowledge and self-care. , 1998, Chest.

[15]  Eunice N. Askov,et al.  Practical Assessment of Adult Literacy in Health Care , 1998, Health education & behavior : the official publication of the Society for Public Health Education.

[16]  L. G. Doak,et al.  Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians , 1998, CA: a cancer journal for clinicians.

[17]  Barry D. Weiss,et al.  Communicating with patients who have limited literacy skills. Report of the National Work Group on Literacy and Health. , 1998, The Journal of family practice.

[18]  Mark V. Williams,et al.  Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. , 1998, Archives of internal medicine.

[19]  Joanne R. Nurss,et al.  Diabetes in Urban African Americans: Functional Health Literacy of Municipal Hospital Outpatients With Diabetes , 1997, The Diabetes educator.

[20]  D W Baker,et al.  The relationship of patient reading ability to self-reported health and use of health services. , 1997, American journal of public health.

[21]  L. G. Doak,et al.  Strategies to improve cancer education materials. , 1996, Oncology nursing forum.

[22]  E. J. Mayeaux,et al.  Parent comprehension of polio vaccine information pamphlets. , 1996, Pediatrics.

[23]  E. J. Mayeaux,et al.  Rapid estimate of adult literacy in medicine: a shortened screening instrument. , 1993, Family medicine.

[24]  J. R. Kicklighter,et al.  Factors Influencing Diabetic Clients' Ability to Read and Comprehend Printed Diabetic Diet Material , 1993, The Diabetes educator.

[25]  Irwin S. Kirsch,et al.  Adult literacy in America , 1993 .

[26]  J. Fain.  Do patients understand what they read? , 1990, The Diabetes educator.

[27]  Doak Cc,et al.  Lowering the silent barriers to compliance for patients with low literacy skills. , 1987 .

[28]  L. G. Doak,et al.  Patient comprehension profiles: recent findings and strategies. , 1980, Patient counselling and health education.