Low Literacy: A Problem in Diabetes Education

Abstract

Eighty-five diabetic patients who were proficient in English were studied to assess the impact of educational material of varying literacy levels on patient comprehension. Two samples of available diabetes foot care material of Grade 11 and 9 readability (measured by SMOG formula) and purposely written in-house material of Grade 6 readability were used. Patients were randomized to read information of either Grade 6 and Grade 11 or Grade 6 and Grade 9 readability. Socio-demographic data and reading habits were collected to allow for identification of literacy markers. The mean CLOZE score (a measure of comprehension) was better in patients who read the Grade 6 information than for both the Grade 11 and Grade 9 information (59.5 +/- 11.8, 46.8 +/- 22.0, 45.8 +/- 22.2 respectively, p < 0.001). When evaluated in terms of percent of patients that could independently understand the material, Grade 6 information outperformed the Grade 11 and Grade 9 information (60%, 19%, 21%, respectively, p < 0.001). For the Grade 11 and Grade 9 information, poorer comprehension was associated with a non-English speaking background, early school leaving age, infrequent reading habits, and preference for tabloids (p < 0.02). Comprehension when patients read the Grade 6 information was no longer dependent on two of the four identified literacy markers. We conclude that reducing literacy demands of health literature improves patients' comprehension. Attention to socio-demographic data and reading habits can assist educators in assessing patients' literacy status and ensuring patients are given literature of compatible readability.

Readability of Patient Education Materials Available at the Point of Care

“…[2][3][4] Additionally, they are potentially effective at improving patient comprehension and influencing health behaviors, especially if they are written at appropriate reading levels for patients. [5][6][7] The Joint Commission 8 states that PEMs should be written at or below a 5 th grade reading level, and encourages hospitals to use readability tests to revise written materials in order to address the health literacy needs of all patients.…”

“…Overland et al 6 compared comprehension of diabetes education materials written at varied grade levels amongst 85 diabetic patients. Patients were randomized to read food care information at 6 th , 9 th , or 11 th grade reading levels.…”

Health literacy and the risk of hospital admission

“…Further studies are necessary to determine whether the results of this study are generalizable to other patient populations, whether the relation results directly from problems with patient-provider communication, and whether innovative approaches to improve communication and patient education can improve outcomes. [37][38][39][40][41][42][43][44][45][46][47][48][49] …”

Low attendance at structured education for people with newly diagnosed type 2 diabetes: General practice characteristics and individual patient factors predict uptake

“…Well known barriers to optimal diabetes self-care include psychological and social factors [13] and low levels of health literacy may discourage attendance or prevent those affected from benefitting from this mode of self-management support [14][15][16][17]. Qualitative research of patient barriers to attending structured education programmes have identified: lack of information regarding DSME from health professionals, not perceiving the benefit of attendance, difficulties in access, and shame and stigma of diabetes [18].…”