An Application of a Diabetes Knowledge Scale for Low-Literate Hispanic/Latinos

Abstract

Purpose. The threefold purpose of this study is to assess diabetes knowledge among Hispanic/Latinos attending a culturally sensitive, empowerment-based, diabetes self-management education program; second, to examine the utility of the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) scale as an assessment tool for this population; and third, to assess the relationship between hemoglobin A1C and knowledge improvement in the intervention group. Method. A prospective, quasi-experimental, repeated-measure design tested pre- and post-A1C and diabetes knowledge using the SKILLD scale. The sample consisted of 71 in the intervention group and 64 controls. Results. Most participants were female, marginally acculturated, and, on average, 60 years of age. Both groups were similar in baseline diabetes knowledge score (median 6 out of 10), and higher literacy was significantly related to increased baseline knowledge. The intervention group significantly improved at follow-up compared with the controls: Participants in the intervention with low baseline knowledge scores had a mean follow-up score of 5.6; those with a high baseline score had a mean score of 7.6. The intervention cohort scored significantly better in knowing why to see an eye doctor, what are normal fasting blood glucose and A1C, and understanding long-term diabetes complications. Increased knowledge of a normal fasting blood glucose level had a significant effect on follow-up A1C in the intervention group. Conclusion. The intervention favorably affects diabetes knowledge, and the SKILLD scale has utility with low-literate Hispanic/Latinos. The significant impact on A1C by diabetes knowledge gain shows that the empowerment-based diabetes self-management education was successful for this ethnic population.

Keywords

Hispanic/Latinos diabetes self-management education SKILLD scale

Get full access to this article

View all access options for this article.

References

American Diabetes Association. (2010). Standards of medical care in diabetes—2011. Diabetes Care, 34(Suppl. 1), S11-S61.

Baker

D. W.

Williams

M. V.

Parker

R. M.

Gazmararian

J. A.

Nurss

(1999). Development of a brief test to measure functional health literacy. Patient Education and Counseling, 38, 33-42.

Bandura

(1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.

Brown

S. A.

Garcia

A. A.

Kouzekanani

Hanis

C. L.

(2002). Culturally competent diabetes self-management education for Mexican Americans. Diabetes Care, 25, 259-268.

Cavanaugh

(2009). Addressing literacy and numeracy to improve diabetes care: Two randomized control trials. Diabetes Care, 32, 2149-2155.

Centers for Disease Control and Prevention. (2010). National diabetes fact sheet: National estimates and general information on diabetes and pre-diabetes in the United States, 2011. Atlanta, GA: Author.

Centers for Disease Control and Prevention, National Diabetes Surveillance System. (2011). County level of diagnosed diabetes: Texas. Retrieved from http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx?mode=DBT

Cryer

Davis

Shamoon

(2003). Hypoglycemia in diabetes. Diabetes Care, 26, 1902-1912.

Firestone

D. N.

Jiménez-Briceño

Reimann

J. O

Talavera

G. A.

Polonsky

W. H.

Edelman

S. V.

(2004). Predictors of diabetes-specific knowledge and treatment satisfaction among Costa Ricans. The Diabetes Educator, 30, 281-292.

10.

Fitzgerald

J. T.

Funnel

M. M.

Hess

G. E.

Barr

P. A.

Anderson

R. M.

Hiss

R. G.

Davis

W. K.

(1998). The reliability and validity of a brief knowledge test. Diabetes Care, 21, 706-710.

11.

Franzini

Fernandez-Esquer

M. E.

(2006). Socioeconomic, cultural, and personal influences on health outcomes in low income Mexican-origin individuals in Texas. Social Science & Medicine, 59, 1629-1646.

12.

Garcia

A. A.

Villagomez

E. T.

Brown

S. A.

Kouzekanani

Hanis

C. L.

(2001). The Starr County diabetes education study: Development of a Spanish-language knowledge questionnaire. Diabetes Care, 24, 16-21.

13.

Guler

Oguz

(2011). The spoken knowledge of low literacy in patients with diabetes. Diabetes Research and Clinical Practice, 92, 238-243.

14.

Johnson

K. L.

Carroll

J. F.

Fulda

K. G.

Cardarelli

(2010). Acculturation and self-reported health among Hispanics using a socio-behavioral model: The North Texas healthy heart study. Public Health, 10(53). Retrieved from http://rd.springer.com/article/10.1186/1471-2458-10-53#page-2

15.

Lara

Gamboa

Kahramanian

M. I.

Morales

L. S.

Bautista

D. E. H.

(2005). Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context. Annual Review of Public Health, 26, 367-397.

16.

Leventhal

Contrada

R. J.

(1998). Self-regulation, health and behavior: a perceptual-cognitive. Psychological Health, 13, 717-733.

17.

Mancuso

J. M.

(2010). Impact on health literacy and patient trust on glycemic control in an urban USA population. Nursing & Health Sciences, 12, 94-104.

18.

Marin

Sabogal

Marin

B. V.

Otero-Sabogal

Perez-Stable

E. J.

(1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9, 183-205.

19.

Mauldon

Melkus

Cagganello

(2006). Tomando control: A culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes—Evaluation of a pilot project. The Diabetes Educator, 32, 751-760.

20.

Murphy

P. W.

Davis

T. C.

Long

S. W.

Jackson

R. H.

Decker

B. C.

(1993). Journal of Reading, 37, 124-130.

21.

Peña-Purcell

Boggess

Jimenez

(2011). An empowerment-based diabetes self-management education program for Hispanic/Latinos: A quasi-experimental pilot study. The Diabetes Educator, 37, 770-779.

22.

Pérez-Escamilla

(2011). Acculturation, nutrition, and health disparities in Latinos. American Journal of Clinical Nutrition, 93(Suppl.), 1163S-1167S.

23.

Philis-Tsimikas

Walker

(2001). Improved care for diabetes in underserved populations. Journal of Ambulatory Care Management, 24(1), 39-43.

24.

Powell

C. K.

Hill

E. G.

Clancy

D. E.

(2007). The relationship between health literacy and diabetes knowledge and readiness to take action. The Diabetes Educator, 33, 144-151.

25.

Reyna

Nelson

Han

(2009). How numeracy influences risk comprehension and medical decision making. Psychological Bulletin, 135, 943-973.

26.

Rosal

M. C.

Olendzki

Reed

G. W.

Gumieniak

Seavon

Ockene

(2005). Diabetes self-management among low-income Spanish-speaking patients: A pilot study. Annals of Behavioral Medicine, 29, 255-259.

27.

Rothman

R. L.

Malone

Bryant

Wolfe

Padgett

DeWalt

D. A.

Pignone

(2005). The Spoken Knowledge in Low Literacy in Diabetes scale: A knowledge scale for vulnerable patients. The Diabetes Educator, 31, 115-224.

28.

Schillinger

Barton

L. R.

Karter

A. J.

Wang

Adler

(2006). Does literacy mediate the relationship between education and health outcomes? A study of low-income population with diabetes. Public Health Reports, 121, 245-254.

29.

Schillinger

Grumbach

Piette

Barton Wang

Osmond

Bindman

A. B.

(2002). Association of health literacy with diabetes outcomes. Journal of the American Medical Association, 288, 475-482.

30.

Texas Center for the Advancement of Literacy and Learning. (2011). Percentage by county of illiterate adult Texans. Retrieved from http://www-tcall.tamu.edu/docs/09illitmap.html

31.

Villagomez

(1989). Health beliefs, knowledge, and metabolic control in diabetic Mexican American adults (Unpublished master’s thesis). The University of Texas Health Science Center, Houston.

32.

Vincent

Pasvogel

Barrera

(2007). The feasibility study of a culturally tailored diabetes intervention for Mexican Americans. Biological Research for Nursing, 9, 130-141.

33.

Weinger

Jacobson

A. M.

Draelos

M. T.

Finkelstein

D. M.

Simonson

D. C.

(1995). Blood glucose estimation and symptoms during hyperglycemia and hypoglycemia in patients with insulin-dependent diabetes mellitus. American Journal of Medicine, 98, 22-31.

34.

Williams

M. V.

Baker

D. W.

Parker

R. M.

Nurss

J. R.

(1998). Relationship of functional health literacy to patients’ knowledge of their chronic disease. Archives of Internal Medicine, 158, 166-172.

35.

World Health Organization. (2012). The Ottawa Charter for health promotion. Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index.html

36.

Zambrana

R. E.

Carter-Pokras

(2010). Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos. American Journal of Public Health, 100, 18-23.