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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louanne smolin and kimberly lawlessThere is little dispute that technology has transformed our everyday lives. We shop online, download news in our iPods, communicate via text and video, take digital photos, and conduct all manner of personal and professional business via the Internet. While these technologies have afforded new opportunities to improve efficiency, exponentially increase access to information, and expand the notion of global citizenship, they have also caused many researchers and educators to rethink what it means to be literate in this post-typographic world (Leu & Kinzer, 2000). It is not enough for citizens in the 21st century to know how to decode and comprehend information as they have in the past. They are also now responsible for efficiently and effectively finding and evaluating information as well as quickly adapting personal learning goals in response to the varied structures and complexities of these technology-enhanced environments (Alexander & Fox, 2004;Dieberger, 1997;Grabinger, Dunlap, & Duffield, 1997). As argued by Dede (this volume), these differences are nontrivial and demand critical reform of our current educational approaches at all levels.Still, the infusion of technology in schools has not yet transformed everyday lives and learning in our nations' schools. Its progression has been slow and labored. Early pressure for integrating technology in schools came from contexts external to the school-most notably from the business sector (Scott, Cole, & Engel, 1992). The American business community became distressed about what was widely perceived as the inadequate preparation of their future workforce when "by the 1980s it began to appear that highly educated workers were needed to run high-technology machinery and that such workers were in increasing demand" (Sherman, 1985). Schools responded to this pressure, but