Development and Pilot Evaluation of Literacy-Adapted Diabetes and CVD Education in Urban, Diabetic African Americans

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Abstract
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.