Health Policy and Health Services Research
Background: Mhealth (mobile health) interventions have provided a way for EDs to aid patients in the management of chronic diseases, including diabetes. However, Little is understood about the role that health literacy plays in mHealth interventions, as low health literacy is associated with low self-efficacy and subsequent poor health outcomes, particularly in diabetes. In this study we evaluate the effects of health literacy on changes in self-efficacy in ED patients participating in a text-message intervention for uncontrolled diabetes.
Methods: Patients with uncontrolled diabetes (HbA1C>8.5) and family members were enrolled in a mHealth intervention designed to improve social support and diabetes self-care available in English and Spanish. Patients reported their demographics, English proficiency and completed a health literacy screen at enrollment. Diabetes specific self efficacy was assessed at enrollment and 3-months. The “Brief Health Literacy Screen” (BHLS) was used to evaluate patient health literacy levels. BHLS of 5 and above was categorized as high health literacy (HHL), while < 5 was categorized as low health literacy (LHL). The “Diabetes Empowerment Scale Short Form” (DES-SF) was used to quantify self efficacy. We examined changes in self-efficacy based on baseline health literacy.
Results: 90 patients were enrolled and had data available for follow-up at 3 months. Baseline HbA1C’s ranged from 8.5% to 15.5%, with a median (interquartile range) of 10.3% (9.4% to 11.7 %). Patients were 54% female with ages ranging from 21 to 65 with a median of 47 years. 96% reported Hispanic/Latino ethnicity with 71% Spanish language preference. Of Spanish speakers, self-reported English proficiency was as follows: 70% not well at all; 20% not well; 9% well; 1% very well. Overall, self-efficacy improved for all patients (LHL mean change in self efficacy: 4.3 vs. HHL mean change in health efficacy 1.9, p 0.089). Patients with LHL showed a trend toward greater change in self-efficacy compared to those with HHL at their 3 month follow up.
Conclusions: In this study of ED patients with diabetes, all patients displayed increased self-efficacy; however LHL patients had slightly greater improvements than HHL patients. Mhealth may be particularly effective for patients with difficulty accessing medical information in more traditional formats.