Evaluation of Nutrition Education Interventions for Type 2 Diabetes: Integrating Nutrition Literacy Assessment and Health Literacy Framework for Effective Communication

BACKGROUND: Nutrition is a critical lifestyle factor for optimizing weight and improving quality of life in diabetes. Diabetes nutrition-management education, therefore, is an important component of comprehensive diabetes care. Benefits of nutrition education in controlling health care costs and safeguarding patients’ quality of life have become evident that educational interventions can make a positive difference for diabetes. However, nutrition management often involves the interpretation and application of oral, written, or quantitative information. Patients with low health literacy and numeracy may have difficulty translating information from traditional diabetes educational programs and materials into effective self-care, which likely leads to poorer diet control and clinical outcomes. Identification of low levels of health literacy is important for effective communication between providers and clients. Assessment instruments for general health literacy are inadequate for use in nutrition education encounters because they do not identify nutrition literacy. OBJECTIVES: By integrating nutrition literacy assessment and health literacy framework, this 2-years proposal aims to 1) to adapt a newly developed Nutrition Literacy Assessment Instrument for diabetes and to pilot test its validity and reliability; 2) to test whether a dietary intervention that combined nutrition literacy assessment with health literacy framework strategies had a better effect on healthy diet behavior and healthcare outcomes for diabetes patients. METHODS: In study 1, questionnaires used in a population-based national nutrition and health status survey (2005-2008 NAHSIT) will be employed as item pools for the development of nutrition literacy assessment tool. Questionnaires include four nutrition knowledge scales, one attitude scale, and one performance scale. The item response theory (IRT) Rasch and graded response model will be used in questionnaire construction and psychometric examination. The resulting questionnaire battery will be reviewed by experts in nutrition or diabetes management which can be adapted to fit into the needs of assessing nutrition literacy for diabetes. In study 2, a total of 120 diabetes patients will be randomized into intervention and control arms and will have a baseline hemoglobin A1c (HbA1c) assay and undergo a baseline survey which includes measures of nutrition literacy, nutrition knowledge, self-efficacy, and diet pattern. During the 3-months period of intervention, while the control group will receive traditional nutrition education, the intervention group will be supplemented with a comprehensive health literacy strategy which includes i) training healthcare providers to employ tools for effective health communication (e.g. conversation map) that address issues related to low literacy, and ii) use of an interactive Diabetes Education Toolkit to improve patient understanding and behaviors. Questionnaire survey and biochemical indicators will be collected upon admission and after 6 months of intervention. It is expected that integrating nutrition literacy assessment and health literacy framework in nutrition education intervention increase its effectiveness for diet behavior change and treatment outcomes for diabetes. CONCLUSIONS: This project will help to develop a comprehensive nutrition literacy assessment tool for diabetes and to demonstrate the value of addressing nutrition literacy and health communication to improve diet management and clinical outcomes among diabetes patients.

Project ID:PF10607-1681
External Project ID:MOST106-2410-H182-022