The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program

Patient Educ Couns. 2009 Jun;75(3):321-7. doi: 10.1016/j.pec.2009.04.001. Epub 2009 Apr 22.


Objective: Multimedia diabetes education programs (MDEP) have the potential to improve communication and education of those with low health literacy. We examined the effect of a MDEP targeted to patients with low literacy on knowledge and assessed the association between literacy and knowledge improvement.

Methods: We showed the MDEP to 190 patients recruited from clinics at a federally qualified health center and an academic health center. We measured diabetes knowledge before and after viewing the MDEP.

Results: Seventy-nine percent of patients had adequate literacy, 13% marginal, and 8% inadequate literacy. Patients across all literacy levels had significant increases in knowledge scores after viewing the MDEP (p-value<0.001). Patients with inadequate literacy learned significantly less after the MDEP (adjusted beta-coefficient=-2.3, SE=0.70) compared to those with adequate literacy.

Conclusions: A MDEP designed for those with low literacy significantly increased diabetes knowledge across literacy levels. However, the MDEP did not overcome the learning gap between patients with low and high literacy.

Practice implications: A literacy appropriate MDEP may be an effective way to teach patients about diabetes. Combining the MDEP with other education methods may improve comprehension and learning among those with low literacy. Research is needed to identify which characteristics of low-literate patients influence the ability to learn health information. Identifying these factors and incorporating solutions into a diabetes education intervention may help bridge the learning gap related to literacy status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Diabetes Mellitus, Type 2*
  • Educational Measurement
  • Educational Status
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Learning*
  • Male
  • Middle Aged
  • Models, Educational
  • Multimedia*
  • Multivariate Analysis
  • Patient Education as Topic*
  • Pilot Projects
  • Program Evaluation
  • Regression Analysis
  • Surveys and Questionnaires