Development and pilot evaluation of literacy-adapted diabetes and CVD education in urban, diabetic African Americans

J Gen Intern Med. 2008 Sep;23(9):1491-4. doi: 10.1007/s11606-008-0679-9. Epub 2008 Jun 3.


Background: Despite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited.

Objective: To describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education.

Design: Materials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design.

Participants: Pilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (n = 15) and Average literacy (n = 15).

Measurements: Wide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale.

Results: Reading grade levels were: > 12th, 30%; 10th-12th, 20%; 7th-9th, 10%; 4th-6th grade, 10%; and < or = 3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of < or = 4th grade. Knowledge improved for Below Average (2.7 to 4.7, p = 0.005) and Average (3.8 to 5.7, p = 0.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients.

Conclusions: Development of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans*
  • Aged
  • Cardiovascular Diseases / ethnology*
  • Diabetes Mellitus, Type 2 / ethnology*
  • Educational Status*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic / methods*
  • Pilot Projects
  • Randomized Controlled Trials as Topic
  • Self Care
  • Urban Population