Development and pilot evaluation of literacy-adapted diabetes and CVD education in urban, diabetic African Americans

BACKGROUND: Despite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited. OBJECTIVE: To describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education. DESIGN: Materials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design. PARTICIPANTS: Pilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (n=15) and Average literacy (n=15). MEASUREMENTS: Wide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale. RESULTS: Reading grade levels were: >12th, 30%; 10th-12th, 20%; 7th-9th, 10%; 4th-6th grade, 10%; and ≥3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of ≥4th grade. Knowledge improved for Below Average (2.7 to 4.7, p=0.005) and Average (3.8 to 5.7, p=0.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients. CONCLUSIONS: Development of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level.