The objective of this project is to test two interventions designed to improve diabetes-related numeracy. Numeracy is the ability to understand and use numbers. People with diabetes use numbers in a variety of ways in managing their condition (e.g., understanding blood sugar values, counting carbohydrates, taking medications at the right dose and time). As part of this project, the investigators developed and pilot tested two interventions to improve diabetes-related numeracy: (1) a series of in-person education classes and (2) a one-time, online diabetes education class. The investigators will look to see whether participants in the education classes show improvements in their diabetes-related numeracy skills, self-care behavior and attitudes, and clinical outcomes (i.e., body mass index, blood pressure, blood sugar \[A1c\]).
Sixty-five American Indians with diabetes were enrolled. Each participant was randomly assigned to 1 of 3 study arms: (1) the in-person education group, (2) the online education group, and (3) a control group. The in-person intervention group attended four class sessions addressing numeracy skills used in the management of diabetes (e.g., counting carbohydrates). The online education group completed a single online module providing training on diabetes-related numeracy skills. The control group received written diabetes educational materials. The investigators collected data at baseline, then again immediately after intervention participation (in-person or online classes), and one final time about three months after the conclusion of the intervention. The investigators will conduct analyses to determine if intervention participants experienced positive changes in diabetes numeracy (the primary outcome) as well as several secondary outcome measures following intervention. Secondary outcomes include: diabetes knowledge, self-efficacy, outcome expectancies, readiness to change, self-care behavior, and clinical outcomes (i.e., body mass index, blood pressure, blood sugar \[A1c\]) . The investigators also will assess whether change in numeracy predicts change in these secondary outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
65
Participants randomized to the in-person education group attended four group classes, each addressing a specific set of diabetes self-care skills (i.e., understanding and using blood glucose numbers, counting carbohydrates, taking medications at the right dose and time). So that each class included a stable group of 8 and 16 participants, we ran classes in "cohorts" of 8-16 people. A participant always attended classes with his/her cohort.
Participants randomized to the online education group attended a single session, at which he/she completed a computerized education module that addressed understanding blood sugar values and using them to examine the impact of food, exercise, and medicines on blood sugar.
Change in Objective Diabetes Numeracy from Baseline to ≈6 weeks
Adapted version of the Diabetes Numeracy Test
Time frame: ≈6 weeks
Change in Objective Diabetes Numeracy from Baseline to ≈3 months
Adapted version of the Diabetes Numeracy Test
Time frame: ≈3 months
Change in Subjective Numeracy from Baseline to ≈6 weeks
Subjective Numeracy Scale
Time frame: ≈6 weeks
Change in Subjective Numeracy from Baseline to ≈3 months
Subjective Numeracy Scale
Time frame: ≈3 months
Change in Diabetes Knowledge from Baseline to ≈6 weeks
Adapted version of the Diabetes Knowledge Test
Time frame: ≈6 weeks
Change in Diabetes Knowledge from Baseline to ≈3 months
Adapted version of the Diabetes Knowledge Test
Time frame: ≈3 months
Change in Diabetes Self-Efficacy from Baseline to ≈6 weeks
Adapted items from existing instruments
Time frame: ≈6 weeks
Change in Diabetes Self-Efficacy from Baseline to ≈3 months
Adapted items from existing instruments
Time frame: ≈3 months
Change in Outcome Expectancies from Baseline to ≈6 weeks
Adapted items from existing instruments
Time frame: ≈6 weeks
Change in Outcome Expectancies from Baseline to ≈3 months
Adapted items from existing instruments
Time frame: ≈3 months
Change in Readiness to Change from Baseline to ≈6 weeks
Newly developed items
Time frame: ≈6 weeks
Change in Readiness to Change from Baseline to ≈3 months
Newly developed items
Time frame: ≈3 months
Change in Diabetes Self-Care Behavior from Baseline to ≈6 weeks
Summary of Diabetes Self-Care Activities Scale plus additional relevant items
Time frame: ≈6 weeks
Change in Diabetes Self-Care Behavior from Baseline to ≈3 months
Summary of Diabetes Self-Care Activities Scale plus additional relevant items
Time frame: ≈3 months
Change in Body Mass Index from Baseline to ≈6 weeks
Body Mass Index
Time frame: ≈6 weeks
Change in Body Mass Index from Baseline to ≈3 months
Body Mass Index
Time frame: ≈3 months
Change in Blood Pressure from Baseline to ≈6 weeks
Systolic and Diastolic Blood Pressure
Time frame: ≈6 weeks
Change in Blood Pressure from Baseline to ≈3 months
Systolic and Diastolic Blood Pressure
Time frame: ≈3 months
Change in Glycemic Control from Baseline to ≈3 months
Hemoglobin A1c
Time frame: ≈3 months
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