Nurse Faculty Scholars - Patient education

The Influence of Literacy on Patient-Reported Experiences of Diabetes Self-Management Support

lsharp — Fri, 17 Dec 2010 14:42:36 +0000

Published Date:

Wed, 2010-12-01 (All day)

Background: Variability in disease-related outcomes may relate to how patients experience self-management support in clinical settings.

Objectives: The purpose of this study was to identify factors associated with experiences of self-management support during primary care encounters.

Methods: A cross-sectional survey was conducted of 208 patients seen in a multidisciplinary diabetes program in an academic medicine clinic. Multiple regression analysis was used to test associations between patient-rated experiences of self-management support (Patient Assessment of Chronic Illness Care) and race, gender, insurance status, literacy, duration of diabetes, and intensity of care management.

Results: The Patient Assessment of Chronic Illness Care ratings decreased with age (r = −.235, p = .001), were higher for women than for men (3.95 vs. 3.65, t = 2.612, p= .010), and were greater for those with more education (F= 3.927, p = .009) and greater literacy skills (t = 3.839, p< .001). The ratings did not vary between racial (t = -1.108, p = .269) or insurance (F = 1.045, p = .374) groups and were unaffected by the duration of diabetes (r= .052, p = .466) and the intensity of care management (F = 1.028, p = .360). In multivariate models, literacy was the only variable contributing significantly to variation in self-management support ratings.

Discussion: Even when considering the objective intensity of health services delivered, literacy was the sole variable contributing to differences in patient ratings of self-management support. Although conclusions are limited by the cross-sectional nature of this study, the results emphasize the need to consider literacy when developing and communicating treatment plans requiring self-management skills.

Background: Variability in disease-related outcomes may relate to how patients experience self-management support in clinical settings.

Objectives: The purpose of this study was to identify factors associated with experiences of self-management support during primary care encounters.

Literacy-appropriate educational materials and brief counseling improve diabetes self-management

nfs — Tue, 28 Sep 2010 14:18:51 +0000

Published Date:

Thu, 2008-07-10 (All day)

Objective

In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care.

Methods

We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients’ activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up.

Results

Statistically significant (p≤0.001) and clinically important (effect sizes=0.29–0.42) improvements were observed in participants’ activation, self-efficacy, diabetes-related distress, self-reported behaviors, and knowledge. Improvements were similar across literacy levels. Spanish speakers experienced both greater improvement in diabetes-related distress and less improvement in self-efficacy levels than English speakers.

Conclusion

A diabetes self-management support package combining literacy-appropriate patient education materials with brief counseling suitable for use in primary care resulted in important short-term health-related psychological and behavioral changes across literacy levels.

Practice implications

Coupling literacy-appropriate education materials with brief counseling in primary care settings may be an effective and efficient strategy for imparting skills necessary for diabetes self-management.

Objective

Evaluation of a visit preparation intervention implemented in two rural, underserved counties of Northern California

nfs — Tue, 28 Sep 2010 12:39:06 +0000

Published Date:

Fri, 2006-12-01 (All day)

Objective

Evaluate satisfaction with visit preparation at three rural resource center sites.

Methods

The resource centers sent eight employees and two volunteers for training at UCSF in Consultation Planning (CP). CP is a service to help patients make a list of questions before seeing their doctors. Researchers used multivariate ordered logistic regression analysis to investigate the variation in satisfaction among 99 CP Clients served by the resource centers in 2003.

Results

Sixty-seven CP Clients who completed surveys were highly satisfied (mean=8.67, standard deviation (S.D.)=1.85, range=5–10). Variation in satisfaction was associated only with whether or not the CP Provider was a breast cancer survivor serving a breast patient (p=0.005). Satisfaction was not associated with CP Client demographics; type of upcoming medical visit; or CP Provider age, remuneration status, nursing background, and volume of CP Clients.

Conclusion

Community-based resource centers have implemented CP to the satisfaction of their clients. Further research should expand the delivery of CP to more underserved members of the community and evaluate its acceptability and impact. There may be a therapeutic alliance formed when survivors provide CP to newly diagnosed patients.

Practice implications

CP should be considered by patient support programs wishing to expand their client services to include visit preparation.

Objective
Evaluate satisfaction with visit preparation at three rural resource center sites.
Methods
The resource centers sent eight employees and two volunteers for training at UCSF in Consultation Planning (CP). CP is a service to help patients make a list of questions before seeing their doctors. Researchers used multivariate ordered logistic regression analysis to investigate the variation in satisfaction among 99 CP Clients served by the resource centers in 2003.
Results