• Felicia Hill-Briggs, Ronda Renosky, Mariana Lazo, Lee Bone, Martha Hill, David Levine, Frederick L Brancati, and Mark Peyrot.
• Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. fbriggs3@jhmi.edu
• J Gen Intern Med. 2008 Sep 1; 23 (9): 149114941491-4.

BackgroundDespite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited.ObjectiveTo describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education.DesignMaterials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design.ParticipantsPilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (n = 15) and Average literacy (n = 15).MeasurementsWide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale.ResultsReading grade levels were: > 12th, 30%; 10th-12th, 20%; 7th-9th, 10%; 4th-6th grade, 10%; and < or = 3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of < or = 4th grade. Knowledge improved for Below Average (2.7 to 4.7, p = 0.005) and Average (3.8 to 5.7, p = 0.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients.ConclusionsDevelopment of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level.

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