Pilot Program

Diabetes: Health Literacy Education Improves Veteran Outcomes

Fed Pract. 2017 January;34(1):32-36

References

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Discussion

The findings from this small pilot study from a single clinic cannot be generalized. However, this pilot study adds to the literature of the positive impact of individualized, structured, tailored nursing interventions delivered with careful consideration of the participants’ personal goals and health care needs for diabetes self-management.

Participants monitored home blood glucose levels, diet, and activity and maintained adherence with prescribed diabetes medications. The HbA_1c level for participants decreased by the end of the program. During the course of the pilot study a pharmacist managed the veterans’ medications. Participant 1 began a new medication regimen the first day of the study. Previously, the patient was self-regulating his medication. However, during the 12-week study, he had no medication adjustments. Participant 4 had several increases to his insulin dose (insulin aspart protamine and insulin aspart rdna origin) during the course of the study. Participants 5 and 6 had no medication adjustments during the study.

Even though participants had medication adjustments, which contributed to the HbA_1c decrease, they became more aware of the medical need to control their blood sugar through the one-on-one education provided. Although there was variation in the depth and detail that participants maintained their food/activity log and home blood glucose monitoring, all participants agreed that they were more likely to be adherent with prescribed self-monitoring “knowing they were going to have to report self-monitoring information” to the RN.

Health care professionals may not realize the impact of familial-social events on blood glucose control. Veterans in this study found that having weekly sessions with the RN helped them through such events, even though they did not adhere strictly to their regimen. One suggestion is having veterans anticipate future familial-social events that may trigger nonadherence to their diabetes health plan and then discuss those events with the health care professional.

Future Research

This small exploratory pilot study has implications for future research. Increasing the study’s sample size and using a control group is recommended to compare veterans who have an educational intervention with those that do not and the impact it has on blood glucose control. The study was limited to 1 CBOC. Incorporating additional CBOCs could increase the sample size. Additionally, although this study was only 3 months in duration, a longer study could reveal significant patterns of change over time as well as the long-term benefit of a tailored educational intervention. In addition, adjusting the study inclusion criteria of > 9 HbA_1cto include those with > 8 HbA_1c also may increase the sample size.

Limited financial resources for the study could have negatively impacted the sample size. Incorporating recruitment or advertising strategy may increase the number of participants. Research also is needed on education interventions with a diverse group of male and female veterans that extends beyond 3 months. Exploring the value of including the veteran’s family in the education sessions is needed. Finally, this study examined only diabetes education. Researchers need to consider other diseases and the value of individualized education.

Limitations 

Limitations included a small sample size and no control group. Due to the study’s small sample size, extrapolating data from it becomes difficult. However, this pilot study sets the groundwork for other researchers to expand the importance of education interventions and health literacy. Recruitment was challenging since an eligibility criterion was the NVS score, and patients were sometimes difficult to contact.⁷ The pilot study started with 6 white male participants but only 4 finished. During the course of the pilot study, 1 veteran had medication adjustments as part of routine care and 1 veteran had medication adjustments prior to the study, which could have altered the HbA_1c results.

In hindsight, using the NVS to assess both prestudy with poststudy health literacy scores would have provided additional information about the education intervention. There is possible bias because the researcher was a VAMC employee, and the RN that implemented the interventions had previously worked with the patients.