African Americans with type 2 diabetes suffer excess disease burden, but cardiovascular disease (CVD) risk factors such as hyperglycemia, hypertension, and dyslipidemia are modifiable with medical management and lifestyle modification. Patient diabetes education and counseling for behavior change are recommended standards of practice to facilitate effective self-management of these risk factors. However, for patients with low literacy or health literacy, accessibility and impact of educational and behavioral interventions are limited. Pilot research suggests that: a) literacy demand and behavioral activation characteristics of patient education modules can be adapted to facilitate learning in urban patients with low literacy, and b) combining literacy- adapted education with problem-solving training facilitates understanding and use of health information for performing self-management in the context of daily life (functional health literacy). Optimal modalities for delivery of a combined patient diabetes education and problem-solving training, and cost-effectiveness of this intervention model, however, are not known. The proposed study will address these needs by testing effectiveness and cost-effectiveness of literacy-adapted diabetes and CVD education and problem-solving training interventions in urban African Americans with type 2 diabetes and high CVD risk profile (suboptimal blood sugar, blood pressure, and/or lipids).
The specific aims of the study are: a) to complete development of a package of literacy-adapted diabetes and CVD patient education materials by developing two video/DVDs addressing self-management recommendations appropriate to the needs, resources, and environment of the population;b) to randomize urban African-American adults with type 2 diabetes and a high CVD risk profile into one of four study arms: Usual Care (Arm 1), Literacy-Adapted Education and Problem-Solving Training Self- Study (Arm 2), Literacy-Adapted Education and Group Problem-Solving Training (Arm 3), and Literacy-Adapted Education and Individual Problem-Solving Training (Arm 4);c) to conduct baseline, 3-month post-intervention, and 6-month post-intervention assessment visits to analyze and compare effectiveness of the literacy-adapted education and problem-solving interventions, as compared to Usual Care, in improving the skills of knowledge, problem-solving and health literacy, behaviors of patient activation and diabetes self-management, and clinical outcomes of A1C, blood pressure and lipids;and d) to perform a cost-effectiveness analysis of each intervention arm as compared to Usual Care. If proven effective, this research will yield low literacy diabetes and CVD patient education and self-management intervention tools for dissemination to high-risk urban minority populations. Moreover, the cost-effectiveness analysis will provide evidence to support decision- making regarding implementation of the models to achieve cardiovascular disease patient self-management goals in clinical practice.

Public Health Relevance

Education and counseling for behavior change are recommended to help people with type 2 diabetes improve high blood sugar, blood pressure, and cholesterol. But, for people who have low literacy or health literacy, understanding and using traditional educational programs is difficult. This study will provide low literacy diabetes and cardiovascular disease education and self-management training tools for use with high-risk urban minority populations and provide evidence to evaluate the costs and benefits of using the literacy-adapted education and problem-solving training programs in clinical practice.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-B (50))
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Kaufmann, Peter G
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Fitzpatrick, Stephanie L; Golden, Sherita Hill; Stewart, Kerry et al. (2016) Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial. Diabetes Care 39:2149-2157
Fitzpatrick, Stephanie L; Schumann, Kristina P; Hill-Briggs, Felicia (2013) Problem solving interventions for diabetes self-management and control: a systematic review of the literature. Diabetes Res Clin Pract 100:145-61
Hill-Briggs, Felicia; Schumann, Kristina P; Dike, Ogechi (2012) Five-step methodology for evaluation and adaptation of print patient health information to meet the < 5th grade readability criterion. Med Care 50:294-301
Majid, Haseeb M; Schumann, Kristina P; Doswell, Angela et al. (2012) Development and evaluation of the DECIDE to move! Physical activity educational video. Diabetes Educ 38:855-9