Assessing Patient Knowledge of Asthma Using a Newly Validated Tool.

OBJECTIVES: To develop and validate a measure of asthma knowledge and to translate and culturally adapt the measure into the Arabic language and context. METHODS: Medically diagnosed individuals 18 years and older were recruited in primary care and specialty asthma clinics in the United Arab Emirates. The National Asthma Education and Prevention Program recommendations for education on asthma were used as a framework to develop the Asthma Knowledge Test (AKT). A measurement scale of "Yes," "No," and "I don't know" was selected. Descriptive statistics were calculated for participant demographics and other healthcare information. Cronbach α ≥ 0.7 was used to measure reliability. Principal component analysis was used to determine the distinct areas of asthma knowledge covered by the AKT. Differences in asthma knowledge depending on sex, age, marital status, and education were tested using multivariate analyses of variance. RESULTS: Cronbach α = .70. Four components were retained and included: asthma as a common disease, triggers and control issues, inhalers, and beliefs and myths. The average AKT score = 13.95 ± 2.77 (range = 5.0-18.0). There was a significant effect of participant level of education on the AKT scores. CONCLUSIONS: The availability of the AKT in Arabic is a valuable addition to the limited available tools related to asthma. As a simple and short tool, it could be used in clinical practice and research to identify specific areas of patient asthma knowledge needing improvements; hence, targeted interventions are sought.

The impact of a self-management educational program coordinated through WhatsApp on diabetes control.

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p<0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p<0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123, p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy.

The impact of a self-management educational program coordinated through WhatsApp on diabetes control

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p < 0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p < 0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p = 0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p = 0.064), 3 months (r=-0.123, p = 0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy

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Translation and culture adaptation of the Simplified Diabetes Knowledge Test, the Literacy Assessment for Diabetes and the Diabetes Numeracy Test.

BACKGROUND: The ability to understand instructions on drug bottles, appointment slips and medical education brochures could be affected by patients' health literacy. Healthcare providers need to be aware of, hence, assess patients' literacy before they develop effective educational strategies for these patients. Many validated instruments have been used to evaluate literacy of diabetic patients in the English language, only a limited number is available in Arabic. OBJECTIVE: To translate and culturally-adapt the Simplified Diabetes Knowledge Test (DKT), the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT) for potential use in Arabic-speaking countries. METHODS: A formal process based on the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines was adopted in translating and culturally adapting the three tools. An expert panel reviewed forward and backward translations of the tools. Ten diabetic patients participated in the cognitive debriefing process to evaluate the tools for clarity, simplicity, and comprehensiveness, and to assess their cultural equivalence. RESULTS: Only minor changes were introduced in tools' design, appearance, and instructions. However, issues identified during the expert panel review and cognitive debriefing led to modifying the tools resulting in item re-wording, addition, deletion or re-arrangement. Terms such as glycosylated hemoglobin, carbohydrates, and infection were adapted to cumulative sugar, starch and microbial inflammation respectively. Issues related to cultural and conceptual equivalence were resolved by replacing words such as kilo instead of pound, and supper instead of dinner, or adding diacritics to the Arabic word for "kidney". The original 43 items of the DNT were reduced to 26, eliminating questions with the same mathematical calculations within each tool domain. CONCLUSIONS: A Culturally equivalent version of the Simplified DKT, LAD and DNT have been developed in the Arabic language available to be used in research and clinical practice in the Arabic speaking countries.