This study designed and piloted an interactive measure to assess learning preferences of Latinos in the United States with diabetes and limited literacy. The measure utilized interactive learning activities to represent four learning styles: visual (seeing), kinesthetic (doing), affective (feeling/sensing), and cognitive (thinking), targeting four diabetes self-management behaviors: choosing healthy foods; understanding portion sizes; distinguishing foods to eat often/sometimes/rarely; and limiting fat. Quantitative data were collected using the Spanish Short Test of Functional Health Literacy in Adults (S-TOFHLA). Individual, structured cognitive interview questions asked participants to identify learning activities that most reflected their own experience with diabetes. Participant observations provided additional qualitative data. Ten Spanish-speaking adults with type 2 diabetes and limited literacy participated in two randomly selected target behaviors and identified easiest and most difficult to understand learning activities. S-TOFHLA scores ranged from 0 to 21 points (mean 7.0) and identified eight participants with inadequate and two with marginal health literacy. Easiest to understand tasks were kinesthetic, most difficult to understand tasks were cognitive. This is one of the first known studies of its kind and offers insight for measuring learning styles of Latinos with diabetes and low health literacy.
Get full access to this article
View all access options for this article.
References
1.
GoodwinN., The Presidential Initiative to Eliminate Racial and Ethnic Disparities in Health: An Interview with the Surgeon General of the United States, David Satcher, Health Promotion Practice, 1, pp. 29–31, 2000.
2.
U.S. Department of Health and Human Services, Diabetes, in Healthy People 2010, Office of Disease Prevention and Health Promotion, Washington, D.C., 2001.
3.
National Institute of Diabetes and Digestive and Kidney Diseases, Total Prevalence of Diabetes by Race/Ethnicity Among People Aged 20 Years or Older, United States, 2005, available at http://www.niddk.nih.gov, accessed September 30, 2006.
4.
Centers for Disease Control and Prevention, National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2002, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia, 2003.
5.
WetterhallS. F.OlsonD. R.DeStefanoF.StevensonJ. M.FordE. S.GermanR. R.WillJ. C.NewmanJ. M.SepeS. J., and VinicorF., Trends in Diabetes and Diabetic Complications, 1980–1987, Diabetes Care, 15: 8, pp. 960–967, 1992.
6.
DiehlA. K. and SternM. P., Special Health Problems of Mexican Americans: Obesity, Gallbladder Disease, Diabetes Mellitus and Cardiovascular Disease, Advances in Internal Medicine, 34: 1, pp. 79–96, 1989.
7.
U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, 1992 National Adult Literacy Survey and 2003 National Assessment of Adult Literacy, available at http://nces.ed.gov/NAAL, accessed September 30, 2006.
8.
SchillingerD.GrumbachK.PietteJ.WangF.OsmondD.DaherC.PalaciosJ.SullivanG. D., and BindmanA. B., Association of Health Literacy with Diabetes Outcomes, Journal of the American Medical Association, 288: 4, pp. 475–482, 2002.
9.
BoulangerP. M.Perez-EscamillaR.HimmelgreenD.Segura-MillanS., and HaldemanL., Determinants of Nutrition Knowledge Among Low-Income, Latino Caretakers in Hartford, Connecticut, Journal of the American Dietetic Association, 102: 7, pp. 978–981, 2002.
10.
VazquezI. M.MillenB.BissettL.LevensonS. M., and ChipkinS. R., Buena Alimentacion, Buena Salud: A Preventive Nutrition Intervention in Caribbean Latinos with Type 2 Diabetes, American Journal of Health Promotion, 13, pp. 116–119, 1998.
11.
von GoelerD. S.RosalM. C.OckeneJ. K.ScavronJ., and DeTorrijosF., Self-Management of Type 2 Diabetes: A Survey of Low-Income, Urban Puerto Ricans, The Diabetes Educator, 29: 4, pp. 663–672, 2003.
12.
KreuterM. W.OswaldD. L.BullF. C., and ClarkE. M., Are Tailored Health Education Materials Always More Effective than Non-Tailored Materials?Health Education Research, Theory and Practice, 15, pp. 305–315, 2000.
13.
Institute of Medicine, Health Literacy: A Prescription to End Confusion, National Academies Press, Washington, D.C., 2004.
14.
RatzanS. C. and ParkerR. M., Introduction, in National Library of Medicine Current Bibliographies in Medicine: Health Literacy, NLM Pub. No. CBM 2000-1, SheldenC. R.ZornM.RatzanS. C., and ParkerR. M. (eds.), National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, 2000.
15.
GazmararianJ. A.BakerD. W.WilliamsM. V.ParkerR. M.ScottT. L.GreenD. C.FehrenbachS. N.RenJ., and KoplanJ. P., Health Literacy Among Medicare Enrollees in a Managed Care Organization, Journal of the American Medical Association, 281: 6, pp. 545–551, 1999.
16.
WilliamsM. V.BakerD. W.ParkesR. M., and NurssJ. R., Relationship of Functional Health Literacy to Patients' Knowledge of their Chronic Disease: A Study of Patients with Hypertension and Diabetes, Archives of Internal Medicine, 158: 2, pp. 166–172, 1998.
17.
RothmanR. L.DeWaltD. A.MaloneR.BryantB.ShintaniA.CriglerB.WeinbergerM., and PignoneM., Influence of Patient Literacy on the Effectiveness of a Primary Care-Based Diabetes Disease Management Program, Journal of the American Medical Association, 292: 14, pp. 1711–1716, 2004.
18.
DoakC. C.DoakL. G., and RootJ. H., Teaching Patients with Low Literacy Skills (2nd Edition), J. B. Lippincott, Philadelphia, Pennsylvania, 1996.
19.
American Association of Diabetes Educators, AADE Position Statement: Individualization of Diabetes Education and Management, The Diabetes Educator, 21: 2, pp. 105–106, 1995.
20.
American Diabetes Association, National Standards for Diabetes Self-Management Education Programs and American Diabetes Association Review Criteria, Diabetes Care, 19(1 suppl.), pp. S114–S118, 1996.
21.
DavisT.CrouchM.WillsG.MillerS., and AbdehouD., The Gap Between Patient Reading Comprehension and the Readability of Patient Education Materials, Journal of Family Practice, 31: 5, pp. 533–538, 1990.
22.
DixonE. and ParkR., Do Patients Understand Written Health Information?Nursing Outlook, 38: 6, pp. 278–281, 1990.
23.
CurryL., Integrating Concepts of Cognitive or Learning Styles: A Review with Attention to Psychometric Standards, Canadian College of Health Services Executives, Ottawa, 1987.
24.
MerriamS. B. and CaffarellaR. S., Learning in Adulthood (2nd Edition), Jossey-Bass Publishers, San Francisco, 1999.
25.
BloomB. S. (ed.), Taxonomy of Educational Objectives, David McKay, New York, 1956.
26.
KolbD. A., Experiential Learning: Experience as the Source of Learning and Development, Prentice-Hall, Englewood Cliffs, New Jersey, 1984.
27.
VellaJ., Learning to Listen, Learning to Teach: The Power of Dialogue in Educating Adults (Revised Edition), Jossey-Bass, San Francisco, 2002.
FlemingN. D. and MillsC., Not Another Inventory, Rather a Catalyst for Reflection, To Improve the Academy, 11, pp. 137–143, 1992.
30.
HawthorneK. and TomilinsonS., One-on-One Teaching with Pictures—Flashcard Health Education for British Asians with Diabetes, British Journal of General Practice, 47(418), pp. 301–304, 1997.
31.
GriggsS. and DunnR., Hispanic-American Students and Learning Style, ERIC Digest, 1996.
32.
Wide Range Inc., Wide Range Achievement Test (WRAT 3), Wide Range Inc., Wilmington, Delaware, 1993.
33.
DavisT. C.LongS. W.JacksonR. H.MayeauxE. J.GeorgeR. B.MurphyP. W., and CrouchM. A., Rapid Estimate of Adult Literacy in Medicine: A Shortened Screening Instrument, Family Medicine, 25: 6, pp. 391–395, 1993.
34.
NurssJ. R.ParkerR. M.WilliamsM. V., and BakerD. W., Test of Functional Health Literacy in Adults (TOFHLA), Peppercorn Books & Press, Snow Camp, North Carolina, 2001.
35.
NathC. R.SylvesterS. T.YasekV., and GunelE., Development and Validation of a Literacy Assessment Tool for Persons with Diabetes, The Diabetes Educator, 272: 6, pp. 857–864, 2001.
36.
WillisG. B., Cognitive Interviewing and Questionnaire Design: A Training Manual, Working Paper Series, No. 7, Office of Research and Methodology, National Center for Health Statistics, Hyattsville, Maryland, March 1994.
37.
JobeJ. B. and MingayD. J., Cognitive Research Improves Questionnaires, American Journal of Public Health, 79: 8, pp. 1053–1055, 1989.
38.
KreuterM. W.BullF. C.ClarkE. M., and OswaldD. L., Understanding How People Process Health Information: A Comparison of Tailored and Nontailored Weight-Loss Materials, Health Psychology, 18: 5, pp. 487–494, 1999.
39.
QuintillianiL. and CarboneE. T., Impact of Diet-Related Cancer Prevention Messages Written in Cognitive and Affective Formats on Message Reactions, Stage of Change, and Self-Efficacy, Journal of Nutrition Education and Behavior, 37: 1, pp. 20–26, 2005.
40.
CarboneE.CampbellM. K., and Honess-MorrealeL., Use of Cognitive Interview Techniques to Inform the Development of Nutrition Surveys and Interactive, Tailored Messages for a Lower Income Population, Journal of the American Dietetics Association, 102: 5, pp. 690–696, 2002.
41.
UlinP. R.RobinsonE. T., and TolleyE. E., Qualitative Methods in Public Health, Jossey-Bass, San Francisco, California, 2005.
42.
KimS.LoveF.QuistbergD. A., and SheaJ. A., Association of Health Literacy with Self-Management Behavior in Patients with Diabetes, Diabetes Care, 27: 12, pp. 2980–2982, 2004.
43.
WalkerE. A.Wylie-RosettJ., and ShamoonH., Health Education for Diabetes Self-Management, in Ellenberg and Rifkin's Diabetes Mellitus (5th Edition), PorteD.SherwinR., and RifkinH. (eds.), Appleton & Lange, Connecticut, pp. 1341–1351, 1997.
44.
KnowlesM. S., The Modern Practice of Adult Education: From Pedagogy to Andragogy (2nd Edition), Cambridge Books, New York, 1980.
45.
FreireP., Pedagogy of the Oppressed (20th Edition), Continuum, New York, 1993. (Originally Seabury, New York, 1972.)
46.
RuddR. E. and ComingsJ. P., Learner Developed Materials: An Empowering Product, Health Education Quarterly, 21: 3, pp. 313–327, 1994.
47.
WalkerE. A., Characteristics of the Adult Learner, The Diabetes Educator, 25(6 Suppl.), pp. 16–24, 1999.
48.
OomenJ. S.OwenL. J., and SuggsL. S., Culture Counts: Why Current Treatment Models Fail Hispanic Women with Type 2 Diabetes, The Diabetes Educator, 25: 2, pp. 220–225, 1999.
49.
ZambranaR. E.MolnarC.MunozH. B., and LopezD. S., Cultural Competency as it Intersects with Racial/Ethnic, Linguistic, and Class Disparities in Managed Healthcare Organizations, American Journal of Managed Care, 10(Special Issue), pp. SP37–44, 2004.
50.
StanleyK., Low-Literacy Materials for Diabetes Nutrition Education, Practical Diabetology, pp. 36–44, 1999.
