Enhancing health literacy and behavioural change within a tele-care education and support intervention for people with type 2 diabetes

Health Expect. 2012 Sep;15(3):267-82. doi: 10.1111/j.1369-7625.2011.00678.x. Epub 2011 Apr 27.


Background: Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making. Health literacy provides an additional, potentially powerful explanatory framework to guide research and practice.

Objective: To examine the changes in the depth and detail of diabetes-related knowledge and confidence for persons with type 2 diabetes.

Design: Two-year, prospective, observational study, using questionnaire data at two time points (baseline and 2 years later) and in-depth interviews with a theoretically selected subsample.

Setting and participants: A total of 319 patients initially recruited from a deprived urban area in north-west England.

Intervention: Dedicated tele-carer education and support, tailored to the individual circumstances of the patient.

Main outcome measures: Perceptions of confidence, levels of empowerment, learning for self-care and most helpful aspects of the intervention.

Results: Over 90% expressed confidence in keeping their blood sugar controlled, and high levels of perceived empowerment (mean = 4.25; 95% CI, 4.17-4.33) were found. Changes in the depth and detail of diabetes-related knowledge and confidence, from the specific to the more general, were observed and enhanced competence in translating knowledge into practice.

Discussion and conclusions: The intervention, built within a developed working partnership between tele-carer and patient, operated at two levels: health literacy, enhancing knowledge, developing personal skills and enabling self-control; and socio-psychological behavioural change, tailored to individuals within their socio-economic environments, enabling increased motivation and supportive problem-solving. Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Caregivers / psychology
  • Diabetes Mellitus, Type 2 / psychology*
  • Diabetes Mellitus, Type 2 / therapy*
  • Diet
  • Exercise
  • Female
  • Glycated Hemoglobin
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice
  • Health Literacy / methods*
  • Humans
  • Male
  • Middle Aged
  • Motivation
  • Patient Education as Topic / methods
  • Prospective Studies
  • Self Care / methods
  • Self Care / psychology
  • Self Efficacy
  • Telephone*


  • Glycated Hemoglobin A