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OBJECTIVES: Coronary heart disease (CHD) is the leading cause of morbidity and mortality among US women. Minority women have higher rates of CHD and are more likely to experience adverse outcomes. Because of racial disparities in CHD outcomes, the purpose of this study was to assess CHD knowledge and awareness in African American and Hispanic women. METHODS: Using a survey research design, a convenience sample of African American and Hispanic women was surveyed in their local communities. CHD knowledge, awareness, and demographic data were collected using an online survey. The survey was administered in English and Spanish using an iPad. CHD knowledge was assessed using a 7-item survey based on the American Heart Association's Life's Simple 7 brochure. CHD awareness was assessed using a 7-item survey adapted from the American Heart Association's Survey of Women's Cardiovascular Disease Awareness. CHD knowledge was scored on a scale of 0 to 7, and awareness was assessed based on responses to each question. The data analysis consisted of cross-tabulations and multivariable repeated measures analysis. We assessed differences in CHD knowledge and awareness based on race/ethnicity. We hypothesized that there would be statistically significant differences in CHD knowledge and awareness based on specific demographic factors (eg, age, income, education, health literacy). RESULTS: A total of 100 African American (n=50) and Hispanic (n = 50) women participated in the study. Results revealed that CHD knowledge and awareness were limited for both groups. Seventy-three percent of participants (African American 66%; Hispanic 80%) did not know that CHD is the leading cause of death in women and 75% (African American 60%; Hispanic 90%) were moderately or not at all informed about CHD. CONCLUSIONS: These findings support the need for more research on innovative strategies to improve CHD knowledge and awareness, particularly in African American and Hispanic women who are at highest risk, thereby addressing racial/ethnic and gender disparities in CHD morbidity and mortality.
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Negro ou Afro-Americano , Conhecimentos, Atitudes e Prática em Saúde , Cardiopatias , Hispânico ou Latino , Feminino , Humanos , Estados Unidos/epidemiologiaRESUMO
The University of Arkansas for Medical Sciences (UAMS) Summer Undergraduate Research Program (SURP) aims to increase diversity in research and health-related careers. The SURP provides underrepresented minority (URM) and disadvantaged students with research, mentoring, and networking experiences; real-life surgical observations; and simulated cardiovascular demonstrations. A postprogram survey was developed to assess program outcomes and explore ways of improving the program to stimulate URM and disadvantaged students' interest in research and health-related careers. This is a report of those postprogram survey findings. Using a survey research design, an online survey was emailed to participants (n = 88). Data were collected for 6 weeks beginning March 2020. There were 37 multiple-choice and open-ended questions regarding education, career choices, and program experiences. Responses were downloaded to statistical software for analyses. Quantitative data were analyzed using descriptive statistics. Major themes were identified for qualitative data. Responses were received from 44.3% (n = 39) of former SURP participants. Overall, 59% stated that the SURP influenced their career goals. When asked about mentor-mentee relationships, 69.3% responded that their interactions were excellent or good; 61.5% maintained contact with their mentor after the SURP. Finally, 79% indicated their SURP experience was excellent or good, and 84.6% would recommend the SURP to others. The SURP has been successful at providing URM and disadvantaged students with positive research experiences and long-term mentor-mentee relationships and has influenced educational and/or career goals. Programs that expose URM and disadvantaged students to basic, clinical, and/or translational research are beneficial for stimulating interest in research and health-related careers.NEW & NOTEWORTHY Mentor-mentee relationships were extremely beneficial as many of the former participants maintained contact with their summer mentor after the program ended. This assessment also revealed that exposing underrepresented and minority students to research has a long-lasting effect on career and educational goals.
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Pesquisa Biomédica , Escolha da Profissão , Humanos , Avaliação de Programas e Projetos de Saúde , Mentores , Estudantes , Ocupações em Saúde , Pesquisa Biomédica/educaçãoRESUMO
Increased opioid use in the United States has resulted in greater incidence of misuse. Orthopaedic patients are more likely to be prescribed opioids for pain. Low health literacy is related to opioid misuse; therefore, orthopaedic patient education tools on use of opioids must be easy to read, understand, and use for patients of all skill levels to be effective. This project aimed to review a broad array of opioid patient education tools and evaluate them from a health literacy perspective. Content evaluation revealed that not all tools expressed the same essential messaging. The mean readability score of the tools assessed was 9.5 grade; higher than the national and recommended 8th-grade reading level. Therefore, many opioid patient education tools may be difficult for patients to read and understand. Improvements in readability and other health literacy best practices are recommended to improve reading, comprehension, and use of opioid patient education tools. (Journal of Surgical Orthopaedic Advances 28(3):232-236, 2019).
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Analgésicos Opioides , Letramento em Saúde , Procedimentos Ortopédicos , Educação de Pacientes como Assunto , Compreensão , Humanos , Internet , Leitura , Estados UnidosRESUMO
Patient health literacy is associated with self-care and management of chronic diseases, including diabetes. Interventions that address health literacy and aim to improve clinical outcomes have been focused mostly in primary care. The purpose of this study was to explore the association between patient health literacy and diabetic foot amputations in a retrospective cohort analysis in a large orthopaedic practice at an academic medical center. Using data extraction from clinical records, orthopaedic patients who had a diabetic foot amputation or re-amputation in the last 2 years were compared with the general orthopaedic patient population, with patient health literacy screening results as the dependent variable. Results revealed a statistically significant difference in health literacy between the foot amputee group (Nâ¯=â¯177) and the general orthopaedic patient group (Nâ¯=â¯14,683) (p < .0001). Patients in the foot amputee group were 8.07 times more likely to have inadequate health literacy than patients in the general orthopaedic patient group. Because diabetic amputations are frequently associated with poorly controlled diabetes, these results provide a strong rationale to develop health literacy-based interventions that address diabetes self-management and foot exams in orthopaedic practices to improve clinical outcomes, including amputation prevention.
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Amputação Cirúrgica , Pé Diabético/cirurgia , Letramento em Saúde , Humanos , Estudos RetrospectivosRESUMO
Health literacy is increasingly understood to be a mediator of chronic disease self-management and health care utilization. However, there has been very little research examining health literacy among incarcerated persons. This study aimed to describe the health literacy and relevant patient characteristics in a recently incarcerated primary care patient population in 12 communities in 6 states and Puerto Rico. Baseline data were collected from 751 individuals through the national Transitions Clinic Network (TCN), a model which utilizes a community health worker (CHW) with a previous history of incarceration to engage previously incarcerated people with chronic medical diseases in medical care upon release. Participants in this study completed study measures during or shortly after their first medical visit in the TCN. Data included demographics, health-related survey responses, and a measure of health literacy, The Newest Vital Sign (NVS). Bivariate and linear regression models were fit to explore associations among health literacy and the time from release to first clinic appointment, number of emergency room visits before first clinic appointment and confidence in adhering to medication. Our study found that almost 60% of the sample had inadequate health literacy. Inadequate health literacy was associated with decreased confidence in taking medications following release and an increased likelihood of visiting the emergency department prior to primary care. Early engagement may improve health risks for this population of individuals that is at high risk of death, acute care utilization, and hospitalization following release.
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Letramento em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto RicoRESUMO
The Institutional Development Award (IDeA) program, housed within the National Institute for General Medical Sciences, administers the Networks of Biomedical Research Excellence (INBRE) as a strategic mission to broaden the geographic distribution of National Institutes of Health (NIH) funding within the United States. Undergraduate summer student mentored research programs (SSMRP) are a common feature of INBRE programs and are designed to increase undergraduate student interest in research careers in the biomedical sciences. Little information is available about student perspectives on how these programs impact their choices relative to education and careers. Therefore, we conducted qualitative interviews with 20 participants from the Arkansas INBRE SSMRP in the years 2002-2012. Each telephone interview lasted 30-45 min. An interview guide with a broad "grand tour" question was used to elicit student perspectives on SSMRP participation. Interviews were digitally recorded, then transcribed verbatim, and the transcript checked for accuracy. Content analysis and constant comparison were used to identify nine themes that were grouped into three temporal categories: before, during, and after the SSMRP experience. Students viewed the experience as positive and felt it impacted their career choices. They emphasized the value of mentoring in the program, and some reported maintaining a relationship with the mentor after the summer experience ended. Students also valued learning new laboratory and presentation skills and felt their research experience was enhanced by meeting students and scientists with a wide range of career interests. These data suggest that the Arkansas INBRE and the NIH IDeA program are successfully meeting the goal of increasing interest in research among undergraduates.
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Pesquisa Biomédica/educação , Currículo , Mentores/educação , Desenvolvimento de Programas/métodos , Universidades , Adulto , Arkansas , Pesquisa Biomédica/métodos , Feminino , Humanos , Masculino , Adulto JovemRESUMO
This study aimed to evaluate patient education materials that are focused on total hip arthroplasty (THA) and total knee arthroplasty (TKA) using health literacy best practices and plain language principles as frameworks. Readability assessments were conducted on a sample of nine patient education documents that are commonly given to THA and TKA surgery patients. Mean readability scores were compared across the sample. The mean readability grade level for the nine arthroplasty educational documents analyzed in this study was 11th grade (10.5). The mean readability ranged from 9th to 12th grade. The documents in this study were written at levels that exceed recommendations by health literacy experts. Health literacy best practices and plain language principles were suggested to reduce the demands on patients so that the documents are easier to understand. Incorporating health literacy best practices into patient education materials for THA and TKA can contribute to improved communication with patients that is necessary for patient understanding and satisfaction. (Journal of Surgical Orthopaedic Advances 27(1):72-76, 2018).
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Artroplastia de Quadril , Artroplastia do Joelho , Compreensão , Letramento em Saúde , Educação de Pacientes como Assunto , HumanosRESUMO
PURPOSE: This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. METHODS: A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. RESULTS: The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. CONCLUSIONS: Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. CLINICAL RELEVANCE: Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients.
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Compreensão , Mãos/cirurgia , Letramento em Saúde , Educação de Pacientes como Assunto , Materiais de Ensino/normas , Estudos de Coortes , Informação de Saúde ao Consumidor/métodos , Feminino , Humanos , Masculino , Melhoria de Qualidade , Sociedades Médicas , Estados UnidosRESUMO
Opioid misuse has been linked to patient health literacy. This study aimed to estimate the prevalence of low health literacy in a sample of orthopaedic patients on opioids. Data were extracted from an electronic medical record database using queries that included an 8-month time frame, active status in an orthopaedic clinic, ICD-10 codes for opioids, and health literacy screening results. In the study sample of 8963 orthopaedic patients, 7103 had opioids in their current chart. Of those patients with opioids in their chart, 1547 had inadequate health literacy as measured by a validated health literacy screening question. Because approximately 22% of orthopaedic patients on opioids may also be at high risk for low health literacy, practices should consider identifying these patients and following national recommendations to tailor patient education so that these patients can better understand the risks, benefits, and dosing of opioids.
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Analgésicos Opioides/uso terapêutico , Letramento em Saúde , Instituições de Assistência Ambulatorial , Estudos Transversais , Humanos , Ortopedia , Educação de Pacientes como Assunto , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Introduction: Diversity can enhance the agenda and quality of biomedical research, but a dearth of underrepresented minorities and women serve as biomedical researchers. The study purpose was to examine the impact of the a summer undergraduate research program on self-efficacy in research, scientific communication, and leadership as well as scientific identity, valuing objectives of the scientific community, and intent to pursue a biomedical research career. Methods: Underrepresented minority and female undergraduate students participated in a mentored research experience in a rural, low-income state. Results: Students' self-efficacy in research, scientific communication, and leadership as well as scientific identity, valuing objectives of the scientific community, and intent to pursue a biomedical research career increased post-program compared to pre-program. Conclusion: This study supports implementation of a biomedical summer undergraduate research program for URM and women in a poor, rural, settings.
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Pesquisa Biomédica , Grupos Minoritários , Pobreza , População Rural , Estudantes , Humanos , Grupos Minoritários/estatística & dados numéricos , Feminino , População Rural/estatística & dados numéricos , Pesquisa Biomédica/educação , Adulto , Escolha da Profissão , Masculino , Adulto Jovem , Autoeficácia , Liderança , Diversidade CulturalRESUMO
The purpose of this study was to identify performance measures of racially underrepresented minority (RUM) Ph.D. trainees who needed additional training initiatives to assist with completing the UAMS biomedical science degree. A sample of 37 trainees in the 10-year NIH-NIGMS funded Initiative for Maximizing Student Development (IMSD) program at the University of Arkansas for Medical Sciences (UAMS) were examined. Descriptive statistics and correlations examined process measures (GRE scores, GPAs, etc.) and outcome measures (time-to-degree, publications, post-doctoral fellowship, etc.) While differences were found, there were no statistically significant differences between how these two groups (Historically Black Colleges and Universities (HBCUs) and Predominately White Institutions (PWIs)) of students performed over time as Ph.D. students. Graduates who scored lower on the verbal section of the GRE also had a higher final graduate school grade point average in graduates who received their undergraduate training from HBCUs. Of the graduates who received their undergraduate training from PWIs, graduates who scored lower on the quantitative section of the GRE had higher numbers of publications. These findings stimulate the need to 1) reduce reliance on the use of the GRE in admission committee decisions, 2) identify psychometrically valid indicators that tailored to assess outcome variables that are relevant to the careers of biomedical scientists, and 3) ensure the effective use of the tools in making admission decisions.
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Sucesso Acadêmico , Educação de Pós-Graduação/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Critérios de Admissão Escolar/estatística & dados numéricos , Adulto , Arkansas , Pesquisa Biomédica/educação , Educação de Pós-Graduação/métodos , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudantes/estatística & dados numéricos , Universidades , Adulto JovemRESUMO
BACKGROUND: Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The How to Talk to Your Doctor (HTTTYD) HANDbook Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care. BRIEF DESCRIPTION OF ACTIVITY: We describe development of the HTTTYD HANDbook Program delivered through the Cooperative Extension Service to educate adults who are eligible for Medicaid and have low health literacy. HTTTYD HANDbook implementation is described using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (and specifically the reach, adoption, implementation, and maintenance dimensions). IMPLEMENTATION: The HTTTYD HANDbook was developed using health literacy best practices with user-centered design, and it was field tested with community members with varying levels of health literacy. Reach, adoption, implementation, and maintenance of the HTTTYD HANDbook were assessed by tracking distribution of HTTTYD HANDbook Program materials, return submission of evaluation and tracking instruments, adherence to program and data collection/submission protocols, and program continuation. RESULTS: Overall reach into the population was 6 per 10,000; about 25% were Medicaid recipients and 28.2% had low health literacy. Most participants were age 65 years or older. Of the 72 counties with program access, 52.7% requested HTTTYD HANDbook Program materials; 31% adopted the program, but only 30% of these counties adhered to program implementation and data collection protocols. Reach and adoption were higher among rural counties, and rural counties were more likely than nonrural counties to maintain the HTTTYD HANDbook Program. LESSONS LEARNED: The HTTTYD HANDbook Program addresses barriers to engagement in patient-provider communication for rural, low-income community members. Programs can be implemented in community settings through established local organizations, such as county extension offices, to increase access for rural adults. Implementation barriers included staff turnover and transportation of program materials. Online facilitator training availability had little impact on adherence to program protocols. Organizational context and established procedures for program delivery and evaluation should be considered in adoption decisions and integrated into implementation protocols. [HLRP: Health Literacy Research and Practice. 2019;3(3):e205-e215.]. PLAIN LANGUAGE SUMMARY: The How to Talk to Your Doctor HANDbook Program was created with people from the community to help patients prepare for doctor visits. The How to Talk to Your Doctor HANDbook Program helps patients to overcome barriers to talking to their doctor so that they can better understand how to get healthy and stay healthy.
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BACKGROUND: Inadequate health literacy is a national health problem that affects about 90 million people from all racial and ethnic groups in the United States. Conceptual and empirical models of health literacy position language as one of the most significant contributors to health literacy. OBJECTIVE: A validated Spanish health literacy screening question asks how confident patients are at filling out medical forms, but it does not clarify whether the forms are in English or in Spanish, contributing to ambiguity and potentially affecting validity. The purpose of this study was to compare responses to questions that clarified the language of the forms referenced in the validated screening question; to explore how the clarified items predicted scores on a measure of health literacy; and to compare the predictive ability of the clarified health literacy items to that of a question about patients' self-reported English proficiency. METHODS: Participants who speak Spanish (N = 200) completed the following surveys: Spanish Health Literacy Screening Question that clarified "English forms" (HLSQ-E) and that clarified "Spanish forms" (HLSQ-S), self-reported English proficiency (SEP), demographic questions, the Short Test of Functional Health Literacy for Adults Spanish (S-TOFHLA-S), and the Newest Vital Sign-Spanish (NVS-Spanish). KEY RESULTS: Participants reported less confidence with English medical forms than Spanish forms. The sensitivity of screening approaches varied; each predicted inadequate health literacy on the NVS-Spanish and S-TOFHLA-S with different levels of sensitivity, specificity, and accuracy. In general, the HLSQ-E was a better predictor of inadequate health literacy than the HLSQ-S; however, the SEP performed nearly as well as the HLSQ-E. CONCLUSION: "How confident are you at filling out medical forms in English " more appropriately identified patients with inadequate health literacy who speak Spanish. Health literacy screening practices should consider the patient's language and the language of the health care system and use questions that are less ambiguous. [HLRP: Health Literacy Research and Practice. 2019;3(2):e110-e116.]. PLAIN LANGUAGE SUMMARY: This project focused on patients who speak Spanish and who have a hard time understanding health information. We wanted to find out the best ways to identify these patients so that doctors and nurses can be sure to give them information in ways that they can understand. We tested screening questions that can identify these patients.
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BACKGROUND: In response to an assessment of organizational health literacy practices at a major academic health center, this case study evaluated the health literacy demands of patient-reported outcome measures commonly used in orthopedic surgery practices to identify areas for improvement. METHODS: A mixed-methods approach was used to analyze the readability and patient feedback of orthopedic patient-reported outcome materials. Qualitative results were derived from focus group notes, observations, recordings, and consensus documents. Results were combined to formulate recommendations for quality improvement. RESULTS: Readability results indicated that narrative portions of sample patient outcome tools were written within or below the recommended eighth-grade reading level (= 5.9). However, document literacy results were higher than the recommended reading level (= 9.8). Focus group results revealed that participants had consensus on 8 of 12 plain language best practices, including use of bullet lists and jargon or technical words in both instruments. CONCLUSIONS: Although the typical readability of both instruments was not exceedingly high, appropriate readability formula and assessment methods gave a more comprehensive assessment of true readability. In addition, participant feedback revealed the need to reduce jargon and improve formatting to lessen the health literacy demands on patients. As clinicians turn more toward patient-reported measures to assess health care quality, it is important to consider the health literacy demands that are inherent in the instruments they are given in our health systems.
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Compreensão , Letramento em Saúde/normas , Ortopedia/normas , Medidas de Resultados Relatados pelo Paciente , Centros Médicos Acadêmicos , Humanos , Idioma , Melhoria de QualidadeRESUMO
Institutions are required to ensure that persons involved in human subjects research receive appropriate human subjects protections training and education. Several organizations use the Collaborative Institutional Training Initiative (CITI) program to fulfill training requirements. Most researchers find the CITI program too complex for community members who collaborate with researchers. This study aimed to determine the readability of CITI modules most frequently used in community-based participatory research (CBPR). The mean readability level of the CITI modules is 14.8 grade; CBPR readability levels ranged from 11.6 to 12.0 grade (sixth- to eighth-grade reading level is recommended). With a baseline objective measure, modifications can be made to improve the plain language quality and understandability of human subjects training modules for community members.
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Pesquisa Participativa Baseada na Comunidade/ética , Compreensão , Educação não Profissionalizante , Experimentação Humana , Leitura , Sujeitos da Pesquisa , Materiais de Ensino/normas , Pesquisa Participativa Baseada na Comunidade/métodos , Ética em Pesquisa/educação , Letramento em Saúde , Humanos , Características de ResidênciaRESUMO
BACKGROUND: Organizational health literacy is the degree to which an organization considers and promotes the health literacy of patients. Addressing health literacy at an organizational level has the potential to have a greater impact on more health consumers in a health system than individual-level approaches. OBJECTIVE: The purpose of this study was to assess health care practices at an academic health center using the 10 attributes of a health-literate health care organization. METHODS: Using a survey research design, the Health Literate Healthcare Organization 10-Item Questionnaire was administered online using total population sampling. Employees (N = 10 300) rated the extent that their organization's health care practices consider and promote patients' health literacy. Differences in responses were assessed using factorial analysis of variance. RESULTS: The mean response was 4.7 on a 7-point Likert scale. Employee training and communication about costs received the lowest ratings. Univariate analyses revealed that there were no statistically significant differences (P = .05) by employees' health profession, years of service, or level of patient contact. There were statistically significant differences by highest education obtained with lowest ratings from employees with college degrees. CONCLUSIONS: Survey responses indicate a need for improvements in health care practices to better assist patients with inadequate health literacy.
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Centros Médicos Acadêmicos/organização & administração , Letramento em Saúde/organização & administração , Cultura Organizacional , Melhoria de Qualidade/organização & administração , Centros Médicos Acadêmicos/normas , Fatores Etários , Atitude , Comunicação , Feminino , Letramento em Saúde/normas , Pesquisa sobre Serviços de Saúde , Humanos , Capacitação em Serviço , Masculino , Melhoria de Qualidade/normas , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários/normasRESUMO
OBJECTIVES: This study assessed patients' health literacy and expectations for total hip (THA) and total knee (TKA) replacement surgery, and compared health literacy levels of patients and their caregivers. METHODS: A convenience sample of 200 THA/TKA participants, patients and their caregivers, participated in this study. RESULTS: Results demonstrated no statistical difference in health literacy between patients and their caregivers. However, patients with lower health literacy had significantly lower expectations for walking after surgery. CONCLUSIONS: Practices should be aware that caregivers may not be any better equipped to consume and use complicated patient education materials than the patient they are assisting. Additionally, lower health literacy, rather than or in addition to race or social factors, may contribute to disparities in opting for THA/TKA because of lower expectations for walking after surgery. PRACTICE IMPLICATIONS: Healthcare practices should develop patient educational materials that are easy for all patients and caregivers to understand, especially those with low health literacy. Additional patient education and counseling may help patients with low health literacy realistically align their expectations and mitigate barriers to consenting to surgery due to low expectations.
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Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Cuidadores/psicologia , Compreensão , Letramento em Saúde , Educação de Pacientes como Assunto , Cuidados Pré-Operatórios , Idoso , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Satisfação do Paciente , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
Proper diabetes self-care requires patients to have considerable knowledge, a range of skills, and to sustain multiple health behaviors. Self-management interventions are needed that can be readily implemented and sustained in rural clinics with limited resources that disproportionately care for patients with limited literacy. Researchers on our team developed an evidence-based, patient-centered, low literacy intervention promoting diabetes self-care that includes: 1) the American College of Physicians (ACP) Diabetes Guide that uses plain language and descriptive photographs to teach core diabetes concepts and empower patients to initiate behavior change; 2) a brief counseling strategy to assist patients in developing short-term, explicit and attainable goals for behavior change ('action plans'); and 3) a training module for health coaches that prepares them to assume educator/counselor roles with the Diabetes Guide as a teaching tool. While the intervention has previously been field tested and found to significantly improve patient knowledge, self-efficacy, and engagement in related health behaviors, its optimal implementation is not known. This project took advantage of a unique opportunity to modify and disseminate the ACP health literacy intervention among patients with type 2 diabetes cared for at rural clinics in Arkansas that are Patient-Centered Medical Homes (PCMH). These practices all had health coaches that could be leveraged to provide chronic disease self-management mostly via phone, but also at the point-of-care. Hence we conducted a patient-randomized, pragmatic clinical trial in 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes.
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Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto/métodos , Assistência Centrada no Paciente/métodos , Autocuidado/métodos , Arkansas , Terapia Comportamental , Diabetes Mellitus Tipo 2/metabolismo , Hemoglobinas Glicadas/metabolismo , Objetivos , Letramento em Saúde , Humanos , Tutoria , População Rural , AutoeficáciaRESUMO
INTRODUCTION: The final rule for the protection of human subjects requires that informed consent be "in language understandable to the subject" and mandates that "the informed consent must be organized in such a way that facilitates comprehension." This study assessed the readability of Institutional Review Board-approved informed consent forms at our institution, implemented an intervention to improve the readability of consent forms, and measured the first year impact of the intervention. METHODS: Readability assessment was conducted on a sample of 217 Institutional Review Board-approved informed consents from 2013 to 2015. A plain language informed consent template was developed and implemented and readability was assessed again after 1 year. RESULTS: The mean readability of the baseline sample was 10th grade. The mean readability of the post-intervention sample (n=82) was seventh grade. CONCLUSIONS: Providing investigators with a plain language informed consent template and training can promote improved readability of informed consents for research.