Table 3.

Literacy Interventions among Persons with Diabetes^a

Study	Sample	Intervention and Control Groups	Results Reported
Echeverry et al.26	166 patients with diabetes hospitalized for cardiovascular disease, 55 years of age or older	I: Education and a low-literacy reminder card describing risk factors of cardiovascular disease. Instructions to discuss the risk factors described on the card with their primary care physician on their first appointment after discharge.	HbA1c (NS); blood pressure (NS); lipid levels (NS); aspirin use higher in control group (p = .001); angiotensinconverting enzyme inhibitor use higher in control group (p = .03)
		C: No Intervention.
Gerber et al.27	244 patients with diabetes	I: Use of computer multimedia that included audio/video sequences to communicate information, provided psychological support, and promoted diabetes selfmanagement skills without extensive text or complex navigation.	HbA1c (NS), weight (NS), blood pressure (NS), knowledge (NS), self-efficacy (NS), self-reported medical care (NS). Increase in perceived susceptibility to diabetes complications in the intervention group was greatest among subjects with lower health literacy. Time spent on the computer was greater for subjects with higher health literacy within the intervention group.
		C: Standard of care only.
Rothman et al.28	217 patients aged 18 years or older with type 2 diabetes and poor glycemic control (HbA1c ≥ 8.0%)	I: All communication to patients was individualized and delivered to enhance comprehension among patients with low literacy. Patients received intensive disease management from a multidisciplinary team.	Among patients with low literacy, intervention patients were more likely than control patients to achieve goal HbA1c levels (≤7.0%) (42% versus 15%, respectively; adjusted OR, 4.6; and 95% CI, 1.3 to 17.2; p =.02). Patients with higher literacy had similar odds of achieving goal HbA1c levels regardless of intervention status (24% versus 23%; adjusted OR, 1.0; and 95% CI, 0.4 to 2.5; p = .98).
		C: Patients received an initial management session and continued with usual care.
Seligman et al.29	63 primary care physicians and 182 patients with diabetes and limited health literacy	I: Physicians were notified if their patients had limited health literacy skills.	Intervention physicians were more likely than control physicians to use management strategies recommended for patients with limited health literacy (OR 3.2, p = .04). Intervention physicians felt less satisfied with their visits (81% versus 93%, p = .01). Intervention physicians felt less effective (38% versus 53%, p = .10). Intervention and control patients' postvisit self-efficacy scores were similar (12.6 versus 12.9, p = .60). And 64% of intervention physicians and 96% of patients felt health literacy screening was useful.
		C: Physicians were not notified if their patients had low health literacy skills.

^aC, control; CI, confidence interval; I, intervention; NS, not significant; OR, odds ratio.