Nourishing Knowledge: Development and Assessment of the Impact of Low-Health Literacy Tailored Nutrition and Healthy Living Educational Handouts in Group Diabetes Management Class Settings

Abstract

In the United States, approximately 37.3 million Americans have type 2 diabetes, with a further 8.6 million individuals undiagnosed. Due to this, over $327 billion is spent annually on diabetes care and management. Furthermore, disparities in diabetes prevalence and outcomes persist, disproportionately impacting socioeconomically disadvantaged communities. Diabetes self-management education (DSME) has emerged as a valuable approach, with its success being studied to improve glycemic control and patient outcomes. However, there is a significant knowledge gap regarding the utilization and effectiveness of DSME among lower-resource, lower-income, and lower-literacy medically underserved patient groups. Research indicates that individuals with limited general literacy, health literacy, and nutrition literacy, which often coincide with lower education and socioeconomic status, face substantial barriers in effectively managing their diabetes diagnosis - more specifically in adhering to medical treatment plans and implementing necessary nutrition and lifestyle changes. Despite the evident need, there is a notable gap in the development and evaluation of diabetes education materials tailored specifically for individuals with lower literacy levels and limited resources. In light of these findings and the disparities that persist in diabetes management, the primary objective of this study is to develop, assess the acceptability of, and evaluate the impact of adapted patient education materials designed to cater to the needs of rural, medically underserved, and uninsured patients diagnosed with Type 2 diabetes. During the Fall semester, DSME handouts were adapted to be more culturally and socioeconomically attuned for patients with low health literacy. Subsequently, in the Spring semester, these adapted handouts are being distributed to patients participating in the Fresh Start group diabetes management classes. At the end of each class, the acceptability, impact, and usefulness of the handouts are assessed using a 6-item survey with quantitative Likert scale and qualitative open-ended questions. Preliminary results have shown that most participants agree that they learned something new from the handouts (84%, n = 31) and will make a change because of it (89%, n = 33). Participants showed the greatest response to learning about food portions and serving sizes when asked about a new topic learned about from the handouts.