Ways to Improve Care in Low Health-Literate Diabetes Patients


Health literacy is a widespread problem in this country, with about 93 million Americans only functioning at a basic health literacy level. This problem is exacerbated in diabetes patients due to the chronic nature of the disease and the constant monitoring and adjusting that need to be done to successfully manage it. While improving health literacy can be a difficult task, according to Andrea S. Wallace, PhD, ND, APRN, BC-ADM, assistant professor at the University of Iowa College of Nursing, there are four ways that physicians can better care for their diabetic patients with a low level of health literacy.


First, it’s important identify the other barriers the patient may face in following the appropriate medical recommendations. Identifying these barriers can be done using open-ended questions instead of the simple yes-no variety. By doing this, physicians should get a better understanding of exactly what their patients understand. In her session, “Health Literacy—Assessing Vulnerable Populations” at the 2010 American Diabetes Association 70 Scientific Sessions, Dr. Wallace said by asking what their normal day is like, finding out about their family structure, and uncovering their medical beliefs will allow physicians to tailor their interventions to each individual patient and give them the best chance for success.

Dr. Wallace also emphasized the importance of improving the communication between physician and patient. Too often physicians talk in jargon or use words that may not be clear to their patient. For example, instead of referring to milk and yogurt as dairy, simply call the products by their name; as simple as it sounds, it could clear up some discrepancies with the patient. Improvements in communication could also be done by limiting their care plan to three key concepts and focusing on only one concept at a time so they can fully grasp one before moving on to the next. Using analogies and defining words they any not understand should also help them better understand how to manage their diabetes.

Another way to improve care in patients with low health literacy is to try and build the patient’s skills. Taking the time to teach specific literacy-based skills to better help them understand their prescription labels, food labels, appoint slips, etc…will put them in a better position to carry out their physician’s recommendations. Dr. Wallace recommended using the Diabetes Literacy and Numeracy Education Tool Kit, which can be found on the Vanderbilt University School of Medicine’s web site.

Finally, physicians should teach behavioral goal setting to their patients. It is important though that the patients initiate the process and that they focus on concrete goals instead of abstract ideas. They should have a set time for accomplishing their goals and they should also truly believe that these goals are attainable. Dr. Wallace recommends that if they are only about a 7 on scale from 1 to 10 in certainty on the goal’s attainment possibility, then the physician should go back and restart the discussion. Diabetes management is about meeting goals and these goals must be achievable, and even more important, the patient must believe they are or they could give up without even trying.

With inadequate health literacy affecting upwards of half the American population, Dr. Wallace believes this issue needs to be tackled immediately and these four steps are a step in the right direction.

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