Improving Diabetes Health Literacy by Animation

Abstract

Purpose and Scope To produce a Spanish/English animated video about diabetes; to qualitatively assess cultural and linguistic appropriateness; and to test effectiveness at improving diabetes health literacy among Latino/Hispanics. Methods Participatory research and animation production methods guided development of the video. Cultural appropriateness was assessed through focused discussion group methods. A prospective randomized controlled trial tested the effectiveness of the Spanish version at improving diabetes health literacy, compared to “easy to read” diabetes information from the National Institute of Diabetes and Digestive and Kidney Diseases. Functional health literacy was measured by the Short Test of Functional Health Literacy in Adults. Diabetes health literacy was measured by the Diabetes Health Literacy Survey (DHLS). Results No significant differences were recorded between experimental (n = 118) and control groups (n = 122) at baseline on demographic characteristics, Short Test of Functional Health Literacy in Adults score, or DHLS score. Fifty-eight percent of the study participants had inadequate functional health literacy. Mean DHLS score for all participants and those having adequate functional health literacy were 0.55 and 0.54, respectively (inadequate diabetes health literacy). When adjusting for baseline DHLS score, sex, age, and insurance status, DHLS scores improved significantly more in the experimental group than the control group (adjusted mean = 55% vs 53%, F = 4.7, df = 1, P = .03). Interaction between experimental group and health literacy level was significant (F = 6.37, df = 2, P = .002), but the experimental effect was significant only for participants with inadequate health literacy (P = .009). Conclusions The positive effect on DHLS scores suggests that animation has great potential for improving diabetes health literacy among Latinos having limited functional health literacy. A study is needed that targets participants with inadequate health literacy and that uses the English and Spanish versions of the video.

Socioeconomic Disparities in Chronic Kidney Disease

“…As health care providers, we can directly address many of the factors crucial for closing the CKD/ESRD disparities gap, and while other factors may seem beyond our reach, we should not turn a blind eye to those elements of institutionalized racism entrenched within the fabric of our society, such as social injustice and human indifference 11,61 . Examples of evidence-based initiatives to mitigate untoward effects of socioeconomic deprivation include expanding awareness of CKD in vulnerable communities and high-risk individuals such as through the National Kidney Foundation Early Evaluation Program or mobile clinics 63–66 and implementing strategies to increase health literacy even among low-educational groups with or at risk for CKD with use of videos and/or novellas, 67,68 the use of social support such as social networks, 19 and primary intervention strategies including the use of lay health workers and patient navigators to address CKD and CKD risk factors ranging from diabetes to childhood chronic diseases 63,66,69,70 . Finally, we should not miss the opportunity to learn important lessons as we strive to advance the necessary policies to improve social welfare and health outcomes, as the existence of health inequities provides unique, unrecognized opportunities for understanding biologic, environmental, sociocultural, and health care system factors that can lead to improved clinical outcomes 4,5,9,60,61 .…”

The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review

“…The findings echoed those of the narrative synthesis (see Table 2 ). All ethnically targeted studies took place in urban American settings, with nearly half (5/11) reportedly recruiting from economically deprived or medically underserved areas [ 56 , 57 , 60 , 61 , 65 ]. More than half (6/11) used phone calls as part of the intervention, although other telehealth media were also used.…”

“…Although only one study offered patients intervention-related equipment (laptop and telehealth peripherals) [ 57 ], six offered financial remuneration ranging from US $40 to US $60 cash or vouchers [ 55 , 59 , 61 - 63 , 65 ], with one trial additionally offering some patients up to US $200 for reducing their HbA 1c levels by a prespecified amount [ 62 ]. The ethnically targeted studies frequently reported tailoring interventions to their target demographic, including offering written and spoken aspects of the intervention in a language other than English [ 56 , 61 , 64 , 65 ], designing interventions through consultation and feedback from minority groups [ 55 - 58 , 60 , 65 ], and using interventionists drawn from the target cultural communities [ 55 , 61 , 64 , 65 ]. This latter point included building input from minorities into the recruitment strategy and/or piloting materials and procedures with them.…”

Methodological review: quality of randomized controlled trials in health literacy

“…Evidence of reporting bias was not generally found, but this may reflect post-hoc addition or omission of intended study outcomes. Also, some studies only achieved statistical significance for outcomes by looking for improvements within subgroups, particularly individuals with the lowest levels of initial health literacy [ 28 , 29 , 43 ]. Subgroup analysis is helpful scientifically and justified given the potentially diverse educational needs of different population groups, but such findings need to be cautiously interpreted.…”