A Health Literacy Intervention for Latina Women with Diabetes

1. A Health Literacy Intervention for Latina Women with Diabetes Maren J. Coffman PhD, RN, CNE Robert Wood Johnson Foundation Nurse Faculty Scholar 2009 Assistant Professor University of North Carolina at Charlotte School of Nursing Laura A. Talbot, EdD, PhD, RN, GCNS-BC Jacqueline Dunbar-Jacob, PhD, RN, FAAN Support for this research was provided by the Robert Wood Johnson Foundation Nurse Faculty Scholars program

2. Background • Type 2 diabetes affects a disproportionate number of Latino adults: nearly 15% of those living in the U.S. have diabetes. • Health literacy is degree to which an individual has the capacity to obtain, process, understand, and act on basic health information and services. • Though most researchers examine health literacy level at a single point in time, research has shown that health literacy can be affected by external and environmental forces and changes over time. CANS September 2012

3. Background • The Latino population is currently the largest minority group in the U.S. • Rapid growth in the Latino population in the Charlotte, NC, region. • 62% of Latinos tested in Spanish had low or marginal health literacy. • 75% of Latino adults living in the U.S. are overweight, and 40% are obese. • Latinos may lack health literacy, and may not be able to obtain or understand information to manage their diabetes. CANS September 2012

4. Specific Aims • 1) Conduct and assess the satisfaction with and feasibility of an intervention for Latina women with type 2 diabetes using a health literacy instructional framework. • 2) Examine the effect of the intervention on nutrition, walking, and blood glucose level. • 3) Examine the effect of the intervention on diabetes self-efficacy and health literacy. CANS September 2012

5. Methods • Culturally appropriate, small group classes designed for low-literate Latina women (N=120) • Randomized intervention/control at 4 study sites • Classes offered once a week for 10 weeks • Class included cooking demonstrations and guided trip to the grocery store and pharmacy to expose participants to healthy foods and self-care treatments • Emphasis on health care system use and health literacy. CANS September 2012

6. Health Literacy Framework • Integrated health literacy training with current diabetes self-management education standards. • Health literacy framework included critical discussion, reading activities, writing activities, group activities, and home activities • Used Living with Diabetes: An Everyday Guide for You and Your Family available in Spanish • Focused on building and mastering health literacy skills and self-efficacy CANS September 2012

7. Demographics • Mean age 49.1 years (SD = 11.3) • 55% of participants from Mexico • 80% spoke little to no English • 50% had low or marginal health literacy • 10% unable to read; not used in analysis • 70% had not completed high school • 40% had no primary care provider • 85% post intervention retention rate CANS September 2012

8. Measures • Data collected at 3 time points including pretest, 4 months post, and 8 months post start date • BMI • A1c using point of care device • Number of servings of vegetable per day measured using National Cancer Institute Multifactor Screener • Walking activity measured using International Physical Activity Questionnaire (IPAQ) • Health literacy measured using short Test of Functional Health Literacy in Adults (TOFHLA) • Diet Self Efficacy Survey • Diabetes Self Efficacy Survey CANS September 2012

9. Results - Aim 1 • Focus group conducted at conclusion of intervention suggested satisfaction with the program • Increased knowledge • Appropriate study materials • Enjoyed pharmacy and grocery store tour • Curriculum was challenging and stimulating • Developed social networks CANS September 2012

10. Results – Aim 2 and 3 *p < .05; **p < .01 CANS September 2012

11. Results – Aim 2 and 3 *p < .05; **p < .01 CANS September 2012

12. Change in Health Literacy CANS September 2012

13. Limitations • Small sample size • Did not examine the effect of the intervention past 8 months • Participants who were unable to read/write not used in analysis • No comparison to standard diabetes self-management education CANS September 2012

14. Conclusions • Significant changes in self-efficacy, health literacy, BMI, and A1c. • Return to baseline effect at third data collection point for BMI and A1c • Need to provide support over longer time frame. • No change in vegetable consumption, though may be limited by self-report. • Change in physical activity was minimal. CANS September 2012

15. Conclusions • Health literacy skills can be learned and applied to real life situations • Sustained change in health literacy in intervention group • The approach can be replicated broadly with other populations, with other chronic illnesses, and in community settings. CANS September 2012