Alliance to Reduce Disparities in Diabetes

Health Literacy Conference - Chicago

The Diabetes Empowerment Program: Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes
Monica E. Peek, MD, MPH, Anna P. Goddu, MSc, Tonya Roberson DT, BA, Deb Maltby MPS, Marshall H. Chin, MD, MP


Our intervention targets the population residing on the South Side of Chicago, a predominantly working class African-American community with substantial racial disparities in community resources (e.g. food deserts, safe recreation) and diabetes outcomes.

The patient empowerment component in this study is part of a multi-targeted intervention called ‘Improving Diabetes Care and Outcomes on the South Side of Chicago,’ which is a collaboration between the University of Chicago, community health centers and community partners. Our work in Chicago is part of national effort on behalf of the Alliance to Reduce Disparities in Diabetes (ARDD) to improve outcomes in our country’s most vulnerable populations.

The patient empowerment intervention was developed using evidence-based, culturally tailored, theoretically driven models of diabetes education and patient empowerment through a multidisciplinary team of nurses, diabetes educators, a social psychologist, physicians, researchers, dieticians, patients and clinical staff.

The 10-session program consists of weekly classes; the first 6 sessions consist of general diabetes education, the next 3 sessions focused on shared decision-making (SDM) and patient/provider communication, and the last session provided a review of curricular materials and additional opportunities to practice self-care and SDM skills. The diabetes education sessions are co-taught by a combination of nurses, diabetes educators and dieticians, all of whom have extensive experience working with African-American patients with diabetes.

Outcomes
Eighty-six percent of the 124 participants attended >70 % of classes. We used the Literacy Assessment for Diabetes (LAD) to measure diabetes health literacy; patients are asked to read 3 columns, each with 20 words, ranked based on level of difficulty. 1 point is given for every correctly pronounced word. Patients had a mean score of 19.7 for the ‘easy’ diabetes words, 19.0 for ‘intermediate’ words and 13.2 for ‘difficult’ words. The total mean was 51.8.

There were improvements in diabetes self-efficacy (mean score of 67.2 vs. 80.0, p<0.0001), self-care behaviors (i.e., number of days following a “healthful eating plan” (mean score of 4.0 vs. 4.5; p=0.02), number of days monitoring blood glucose as recommended by healthcare provider (mean score of 3.6 vs. 5.1; p=0.0001), and the number of days the inside of shoes were checked (mean score of 4.0 vs. 4.8; p<0.001)).

In addition, statistically significant improvements were seen in some intermediate clinical measures such as diabetes control (hemoglobin A1c of 8.8 vs. 8.2, p=0.01), diastolic blood pressure (81.7 vs. 77.4 mmHg, p=0.002) and HDL cholesterol (51.1 vs. 49.4, p=0.03).

Implications
Combining tailored education with shared decision-making may be a promising strategy for empowering low-income, low-literacy African-Americans and improving health outcomes.