Accessible diabetes education materials in low-vision format

"The More I Do, the Better I'll Be": The Treatment Preferences of Type 2 Diabetes Among African American Men

To gain better insight to the preferred methods of managing and treating type 2 diabetes among African American men (AA men). Participants ( n = 19) were AA men aged 35 to 69 years, who were diagnosed with type 2 diabetes. Participants were recruited via community outreach efforts, including barbershops and churches located in predominantly African American communities in Southeast United States. On consent, individual interviews were conducted, audio recorded, and subsequently transcribed. Transcripts were analyzed using a phenomenological approach, and focused on identifying common themes among the descriptions of AA men's experiences specific to type 2 diabetes. Participants' statements indicated three main commonalities regarding treatment preferences which were medication, dietary changes, and increase in exercise. Some participants from the study stated that they preferred taking oral medication primarily out of convenience, lack of pain, and how well the medicine makes them feel. Others stated educating themselves and having a consistent relationship with the diabetes physician has assisted them the most. Other participants shared preferences of being dedicated to proper diet and exercise without any medication (pill or injection), as well as maintaining the mental motivation needed to sustain management. Some participants preferred to not take an oral pill, while some did not mind taking pills at all. For some of the participants, it appears that it is easier for them to manage their diabetes by prescription medication than by lifestyle changes such as diet and exercise. Future studies are needed to investigate how social support system also assists these men in managing their diabetes.

Creating low vision and nonvisual instructions for diabetes technology: an empirically validated process

INTRODUCTION

Nearly 20% of the adults with diagnosed diabetes in the United States also have visual impairment. Many individuals in this group perform routine diabetes self-management tasks independently, often using technology that was not specifically designed for use by people with visual impairment (e.g., insulin pumps and pens). Equitable care for persons with disabilities requires providing instructions in formats accessible for nonreaders. However, instructions in accessible formats, such as recordings, braille, or digital documents that are legible to screen readers, are seldom available.

METHOD

This article includes a summary of existing guidelines for creating accessible documents. The guidelines are followed by a description of the production of accessible nonvisual instructions for use of insulin pens used in a study of dosing accuracy. The study results indicate that the instructions were used successfully by 40 persons with visual impairment.

DISCUSSION AND CONCLUSIONS

Instructions in accessible formats can increase access to the benefits of diabetes technology for persons with visual impairment. Recorded instructions may also be useful to sighted persons who do not read well, such as those with dyslexia, low literacy, or who use English as a second language. Finally, they may have important benefits for fully sighted people who find it easier to learn to use technology by handling the equipment while listening to instructions. Manufacturers may also benefit from marketing to an increased pool of potential users.

Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample

BACKGROUND

Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change.

OBJECTIVE

To pilot test feasibility, acceptability, and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility.

DESIGN

Two-arm randomized controlled trial powered to detect a 0.50% change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis.

PARTICIPANTS

Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar, blood pressure, or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization.

INTERVENTIONS

A group, problem-based diabetes self-management training designed for delivery in an intensive and a condensed program format. Three intensive and three condensed program groups were conducted during the trial.

MAIN MEASURES

Clinical (A1C, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL and HDL cholesterol) and behavioral (knowledge, problem solving, self-management behavior) data were measured at baseline, post-intervention, and 3 months post-intervention (corresponding with 6-9 months following baseline).

RESULTS

Adoption of both programs was high (>85% attendance rates, 95% retention). At 3 months post-intervention, the between-group difference in A1C change was -0.72% (p = 0.02), in favor of the intensive program. A1C reduction was partially mediated by problem-solving skill at follow-up (ß = -0.13, p = 0.04). Intensive program patients demonstrated within-group improvements in knowledge (p < 0.001), problem-solving (p = 0.01), and self-management behaviors (p = 0.04). Among the subsets of patients with suboptimal blood pressure or lipids at baseline, the intensive program yielded clinically significant individual improvements in SBP, DBP, and LDL cholesterol. Patient satisfaction and usability ratings were high for both programs.

CONCLUSIONS

A literacy-adapted, intensive, problem-solving-based diabetes self-management training was effective for key clinical and behavioral outcomes in a lower income patient sample.

A comparison of dosing accuracy: visually impaired and sighted people using insulin pens

BACKGROUND

In the United States, 18% of people with diagnosed diabetes have visual impairment. Insulin pens are widely used by both blind and sighted people. However, major manufacturers include a disclaimer in the instructions warning against use by visually impaired people, without giving a rationale. Published studies neither support nor refute the disclaimer.

METHOD

The purpose of this study was to compare accuracy of dosing with insulin pens between visually impaired and sighted people. Inclusion criteria were self-reported diabetes and inability (visually impaired group) or ability (sighted group) to read regular print. The sole exclusion criterion was inability to pass a brief test of decisional capacity. Each participant received standardized instructions for insulin pen use, either in recorded (visually impaired group) or in printed (sighted group) format, and delivered 10 systematically varied doses into an injection ball, which was weighed on a precision laboratory balance.

RESULTS

No significant correlation with accuracy of insulin dosing was found for any of the analyzed variables: visual status, age, gender, years of having diabetes mellitus (DM), or treatment of DM with or without insulin.

CONCLUSIONS

This study provided preliminary evidence of the safety of use of insulin pens by visually impaired people and raised questions about the validity of the disclaimer. Further study of the safety of use of insulin pens by blind people is needed. Inclusion of people with disabilities in research on technology intended for patient use would ensure that people with disabilities can benefit from new technology.

Making diabetes education accessible for people with visual impairment

PURPOSE

The purpose of this study was to identify changes needed to make the diabetes education materials and programs of the Diabetes Association of Greater Cleveland (DAGC) accessible for people who have visual impairment and diabetes (PVID).

METHODS

Using the principles and techniques of participatory action research (PAR), 5 PVID and 4 staff members of a local diabetes association met once a month for a year to plan, implement, and evaluate progress toward full accessibility of all diabetes education materials and programs. The researcher served as facilitator.

RESULTS

Four "transformational moments" are presented through which the PAR process enabled PVID and diabetes professionals to learn to understand and trust each other. Changes made to increase accessibility included production of 2 recordings for providing access to print information about diabetes; planning public education program publicity and locations for access; development of guidelines to help speakers make their diabetes education presentations accessible for people who cannot see slides and gestures; and presentation of an inservice for the entire staff of the diabetes association, including information about how they live with visual impairment, and common courtesies that make communication with PVID more effective.

CONCLUSIONS

Diabetes education programs should include planning for full accessibility for PVID. Diabetes organizations should publish teaching materials in accessible format.

Development and pilot evaluation of literacy-adapted diabetes and CVD education in urban, diabetic African Americans

BACKGROUND

Despite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited.

OBJECTIVE

To describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education.

DESIGN

Materials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design.

PARTICIPANTS

Pilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (n = 15) and Average literacy (n = 15).

MEASUREMENTS

Wide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale.

RESULTS

Reading grade levels were: > 12th, 30%; 10th-12th, 20%; 7th-9th, 10%; 4th-6th grade, 10%; and < or = 3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of < or = 4th grade. Knowledge improved for Below Average (2.7 to 4.7, p = 0.005) and Average (3.8 to 5.7, p = 0.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients.

CONCLUSIONS

Development of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level.

Improving Effectiveness of Nutrition Education Resources for Older Adults

This article discusses published reports and studies from the past decade that focused primarily on using written or other tangible nutrition educational resources with older adults, such as brief "handouts," newsletters, brochures, booklets, curricular lessons, board games, audiotapes and videotapes. Studies of health professionals' needs and desires for such materials are also reviewed. Thirteen articles, of which four were theory-based, were found. They are summarized in tables that include details regarding the educational resource(s) used; a description of the subjects and controls, if any; the evaluation methods used; and results obtained. Ten practical suggestions are offered to help educators select or develop more effective printed, audiotape, videotape and other tangible nutrition education resources appropriate for older adults. Much research remains to be done in this area. This article is one of a series of literature reviews of topics related to nutrition education for older adults.

Diabetes education for people with disabilities

The AADE recognizes the special diabetes education and care needs of people with disabilities. The Americans with Disabilities Act requires that diabetes educators provide reasonable accommodations to people with disabilities in response to their particular individual needs. This position statement has been developed to provide guidance to diabetes educators regarding their ethical and legal responsibilities to people with disabilities, and to promote diabetes education for people with disabilities that is equal in quality to that received by people with no current disability.

A focus group study of accessibility and related psychosocial issues in diabetes education for people with visual impairment

PURPOSE

This study was conducted to identify accessibility and related psychosocial issues in diabetes care and education for visually impaired adults who have diabetes.

METHODS

Two focus groups of adults with visual impairment and diabetes were conducted; data were recorded and analyzed.

RESULTS

The 3 main issues identified were lack of access to up-to-date diabetes information in an accessible format, lack of understanding by healthcare providers of the needs and competencies of people with both visual impairment and diabetes, and lack of access to nonvisual diabetes self-management equipment.

CONCLUSIONS

This study provides qualitative support for the view that visually impaired people in the United States may, as a group, be systematically excluded from receiving high quality diabetes care and education. Equal access to diabetes care and education for visually impaired people requires increased accessibility of diabetes care and education programs, and increased professional and public awareness that the diabetes programs are accessible. Some specific recommendations are to make all patient education materials available in low-vision/nonvisual formats and to teach all diabetes education professionals how to work effectively with visually impaired people.