Alliance to Reduce Disparities in Diabetes

Health Literacy Conference - Cross-Site Evaluation (Midterm Results)

Implementing Diabetes Self-Management Programs for Patients with Low Literacy: Midterm Process Evaluation Results from the Alliance to Reduce Disparities in Diabetes
Lewis, M.A., Williams, P., Hobbs, C., Burton, J., Heminger, C., Moultrie, R., Fitzgerald, T., Taylor, O., Holt, S., & Kamerow, D. 

The Alliance to Reduce Disparities in Diabetes, sponsored by The Merck Company Foundation, is a consortium of five grantees, a National Program Office based at the University of Michigan, and an external independent evaluator, RTI International. The Alliance integrates innovative clinician and patient education and quality of care improvements aimed at underserved patients with diabetes who have low literacy. The purpose of this presentation is to report on the key themes emerging across the sites that illuminate how they have implemented their programs from inception to midway through their projects, specifically focused on the patient self-management program components that are serving low literacy patients.

The grantees’ programs focus on reducing disparities in diabetes care and enhancing outcomes through clinical and community interventions. The grantee sites have enrolled a multiracial patient group and implemented multilevel and multicomponent interventions to enhance patient skills, clinician cultural competencies, and health care systems changes to address disparities and enhance care.   

As part of the evaluation, RTI International is also conducting a qualitative process evaluation. Process evaluations answer key questions about program implementation, program utility, and process analysis. Describing these processes allows program implementers to identify with greater certainty which specific intervention processes contribute to observed health outcomes.

Process Evaluation Results 
Several cross-site themes emerged that illustrate how programs have been serving low literacy patients managing diabetes. All themes focus on creating a supportive environment for patients and their health care providers that foster meaningful and productive interactions.

  • Sites are increasing patient education and empowerment through the use of low-cost, pre-existing educational materials that have been adapted for local clientele, coaching patients to know what to expect and say during medical encounters, and providing easy-to-use information that patients can carry with them as reminders, such as pocket cards.
  • Sites are enhancing patient and provider communication skills by using culturally appropriate language, shared decision-making and goal setting techniques, providing clinicians with training to enhance sensitivity and cultural competence, and tailoring program materials and treatment options to increase relevance and appeal for patients.
  • Sites are providing resources and support that extend beyond the clinic and support self-management by inviting patients’ family members to attend educational sessions, tapping into community resources and partnerships, and using community health workers who are embedded in neighborhoods and communities where patients live and work.
  • Sites are making changes in clinic workflow and systems such as implementing electronic medical records that capture important patient data, changing workflow so that patients provide intake and medical history information before seeing a health care provider, intensifying treatment by providing additional clinical staff such as nurse practitioners. These changes create higher-quality encounter time with providers.  

Based on mid-term process evaluation findings, reaching low literacy patients with diabetes to support self-management requires a comprehensive approach that involves: empowering and educating patients and providers, involving families and community supports, and changes in clinic workflow and health care delivery. Each of these factors contributes to a productive and meaningful relationship between patients and health care providers at the point of care.