Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial
Background Adults with diabetes mellitus (DM) living in rural areas often face limited access to medical and specialist care, minimal exposure to diabetes education, and transportation challenges. Rural residents also tend to be older, poorer, less educated, under-insured and have lower health liter...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2024-12-01
|
| Series: | Health Literacy and Communication Open |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/28355245.2024.2382133 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850251445527379968 |
|---|---|
| author | Laura M. Curtis Terry C. Davis Connie L. Arnold Jennifer M. Gan Jean C. McSweeney Scott Hur Mary J. Kwasny Michael S. Wolf Kristie Hadden |
| author_facet | Laura M. Curtis Terry C. Davis Connie L. Arnold Jennifer M. Gan Jean C. McSweeney Scott Hur Mary J. Kwasny Michael S. Wolf Kristie Hadden |
| author_sort | Laura M. Curtis |
| collection | DOAJ |
| description | Background Adults with diabetes mellitus (DM) living in rural areas often face limited access to medical and specialist care, minimal exposure to diabetes education, and transportation challenges. Rural residents also tend to be older, poorer, less educated, under-insured and have lower health literacy compared to their urban counterparts.Aims We tested the effectiveness of the American College of Physicians (ACP) diabetes health literacy intervention in rural community clinics to improve a range of diabetes-related patient outcomes and determine whether the intervention reduces disparities by health literacy.Methods We recruited 756 English-speaking adults with uncontrolled Type 2 DM from rural clinics in Arkansas. Trained health coaches reviewed the ACP Diabetes Guide and conducted counseling and action-planning monthly to participants randomized to the intervention. The enhanced usual care (EUC) arm received an American Diabetes Association workbook and was followed as usual. Interviews were conducted at baseline, 3 and 6 months, and clinical outcomes, including hemoglobin A1C and blood pressure values, were extracted from charts through 12 months post-baseline. Health literacy was measured at baseline using the Newest Vital Sign (NVS). Our primary outcome was A1C at 6 months, with other clinical values and self-reported diabetes-related knowledge, self-efficacy, distress, and self-care behaviors examined as secondary outcomes.Results Participants had a mean age of 55.8 (SD = 11.7), 68% were female, two-thirds had an annual household income <$15,000, and 52% had limited health literacy. Overall, the intervention had little effect on outcomes at 6 and 12 months, including our primary outcome of A1C at 6 months (Intervention Least Squared Means (LSM) 8.28, 95% CI 8.11, 8.46; EUC LSM 8.44, 95% CI 8.26, 8.61). Diabetes knowledge was greater in those with adequate (LSM 9.46, 95% CI 9.25, 9.67) compared to those with limited health literacy (LSM 8.11, 95% CI 7.91, 8.23, p < 0.001) at baseline. This disparity remained in the EUC arm after 6 months but disparities were mitigated in the intervention arm (interaction p < 0.001).Discussion Our intensive intervention was well received, but insufficient to improve outcomes. Strategies may need to attend to other barriers faced by rural patients beyond health literacy to improve health behaviors and outcomes. |
| format | Article |
| id | doaj-art-adbc99debba2415a8ec6b2ea6de8bf06 |
| institution | OA Journals |
| issn | 2835-5245 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Health Literacy and Communication Open |
| spelling | doaj-art-adbc99debba2415a8ec6b2ea6de8bf062025-08-20T01:57:54ZengTaylor & Francis GroupHealth Literacy and Communication Open2835-52452024-12-012110.1080/28355245.2024.2382133Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trialLaura M. Curtis0Terry C. Davis1Connie L. Arnold2Jennifer M. Gan3Jean C. McSweeney4Scott Hur5Mary J. Kwasny6Michael S. Wolf7Kristie Hadden8Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USADepartment of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, USADepartment of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, USADepartment of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, AR, USACollege of Nursing - Research, University of Arkansas for Medical Sciences, Little Rock, AR, USADivision of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USADepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USADivision of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USADepartment of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, AR, USABackground Adults with diabetes mellitus (DM) living in rural areas often face limited access to medical and specialist care, minimal exposure to diabetes education, and transportation challenges. Rural residents also tend to be older, poorer, less educated, under-insured and have lower health literacy compared to their urban counterparts.Aims We tested the effectiveness of the American College of Physicians (ACP) diabetes health literacy intervention in rural community clinics to improve a range of diabetes-related patient outcomes and determine whether the intervention reduces disparities by health literacy.Methods We recruited 756 English-speaking adults with uncontrolled Type 2 DM from rural clinics in Arkansas. Trained health coaches reviewed the ACP Diabetes Guide and conducted counseling and action-planning monthly to participants randomized to the intervention. The enhanced usual care (EUC) arm received an American Diabetes Association workbook and was followed as usual. Interviews were conducted at baseline, 3 and 6 months, and clinical outcomes, including hemoglobin A1C and blood pressure values, were extracted from charts through 12 months post-baseline. Health literacy was measured at baseline using the Newest Vital Sign (NVS). Our primary outcome was A1C at 6 months, with other clinical values and self-reported diabetes-related knowledge, self-efficacy, distress, and self-care behaviors examined as secondary outcomes.Results Participants had a mean age of 55.8 (SD = 11.7), 68% were female, two-thirds had an annual household income <$15,000, and 52% had limited health literacy. Overall, the intervention had little effect on outcomes at 6 and 12 months, including our primary outcome of A1C at 6 months (Intervention Least Squared Means (LSM) 8.28, 95% CI 8.11, 8.46; EUC LSM 8.44, 95% CI 8.26, 8.61). Diabetes knowledge was greater in those with adequate (LSM 9.46, 95% CI 9.25, 9.67) compared to those with limited health literacy (LSM 8.11, 95% CI 7.91, 8.23, p < 0.001) at baseline. This disparity remained in the EUC arm after 6 months but disparities were mitigated in the intervention arm (interaction p < 0.001).Discussion Our intensive intervention was well received, but insufficient to improve outcomes. Strategies may need to attend to other barriers faced by rural patients beyond health literacy to improve health behaviors and outcomes.https://www.tandfonline.com/doi/10.1080/28355245.2024.2382133Diabetes educationrural healthhealth literacypragmatic trial |
| spellingShingle | Laura M. Curtis Terry C. Davis Connie L. Arnold Jennifer M. Gan Jean C. McSweeney Scott Hur Mary J. Kwasny Michael S. Wolf Kristie Hadden Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial Health Literacy and Communication Open Diabetes education rural health health literacy pragmatic trial |
| title | Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial |
| title_full | Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial |
| title_fullStr | Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial |
| title_full_unstemmed | Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial |
| title_short | Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial |
| title_sort | effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics a randomized pragmatic trial |
| topic | Diabetes education rural health health literacy pragmatic trial |
| url | https://www.tandfonline.com/doi/10.1080/28355245.2024.2382133 |
| work_keys_str_mv | AT lauramcurtis effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT terrycdavis effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT connielarnold effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT jennifermgan effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT jeancmcsweeney effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT scotthur effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT maryjkwasny effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT michaelswolf effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial AT kristiehadden effectivenessofahealthliteracyinterventiontoimprovediabetesoutcomesinruralfamilymedicineclinicsarandomizedpragmatictrial |