Implementation and evaluation of a low health literacy and culturally sensitive diabetes education program

J Healthc Qual. Nov-Dec 2014;36(6):16-23. doi: 10.1111/jhq.12021. Epub 2013 Jun 25.


Low health literacy is more prevalent in persons with limited education, members of ethnic minorities, and those who speak English as a second language, and is associated with multiple adverse diabetes-related health outcomes. This study examined the effectiveness of a low health literacy and culturally sensitive diabetes education program for economically and socially disadvantaged adult patients with type 2 diabetes. A pre-post prospective study design was used to examine outcomes over 12 months. Outcome measures included diabetes knowledge, self-efficacy, and self-care, measured using reliable and valid survey tools, and A1C. Over this period of time 277 patients were enrolled in the program, with 106 participants completing survey data. At the completion of the program patients had significant improvements in diabetes knowledge (p < .001), self-efficacy (p < .001), and three domains of self-care including diet (p < .001), foot care (p < .001), and exercise (p < .001). There were no significant improvements in the frequency of blood glucose testing (p = .345). Additionally, A1C values significantly improved 3 months after completing the program (p = .007). In conclusion, a diabetes education program designed to be culturally sensitive and meet the needs of individuals with low health literacy improves short-term outcomes.

Keywords: diabetes education; low health literacy; socially and economically disadvantaged patients.

MeSH terms

  • Adult
  • Blood Glucose Self-Monitoring
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Behavior
  • Health Knowledge, Attitudes, Practice
  • Health Literacy*
  • Hispanic or Latino / education
  • Humans
  • Language
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Prospective Studies
  • Self Care*
  • Self Efficacy


  • Glycated Hemoglobin A