Development and pilot of a low-literacy diabetes education book using social marketing techniques

INTRODUCTION: The primary objective of this work was to develop a diabetes education book, to pilot its use, and to evaluate its impact on patient care. The secondary objective was to compare the value of providing only the book to patients versus providing the book along with a brief tutorial given by a nurse on how to use the book. METHODS: A diabetes education book was developed through a social marketing approach. The impact of the book was then tested in a pilot, prospective, randomized controlled trial evaluating diabetes knowledge, emotional distress, self-care behavior, and clinical outcomes in a primary care patient population. The three-arm study randomized one group to usual care (n=33), one group to receive the book alone (n=33), and one group to receive the book with a brief nurse tutorial (n=34). Patients completed surveys at baseline, 4 weeks, 3 months, and 6 months to assess knowledge (Knowledge Questionnaire), self-care behaviors (Summary of Diabetes Self Care Activities [SDSCA] survey), and disease-related distress (Problem Areas in Diabetes [PAID] scale). RESULTS: A patient advocacy committee identified a need for information on basic diabetes knowledge, diet, medications, complications, preparing for a visit, and plans for daily life. Using social marketing with a focus on low literacy, the Penn State Hershey Diabetes Playbook was created. The pilot study showed a trend towards improved knowledge, decreased distress, and improved self-care behaviors in patients who received the book. There was no difference in outcomes in patients who were provided the book alone versus those who received a brief nurse tutorial along with the book. CONCLUSION: Social marketing techniques and low literacy awareness are useful in developing diabetes educational materials.