Engaging physicians and empowering patients for improved self-management in diabetes care through better defined health literacy needs

From the 2021 HVPAA National Conference

Christine Junia (Loyola Medicine- MacNeal Hospital), Akshata Chaugule, Amulya Reddy Kasireddy, Daniele Restifo, Umer Farooq, Umme Malwi, Ayesha Ikram, Deyger Navarette


Our community-based residency program clinic serves a diverse community. Varying patient health literacy needs is a challenge we have not addressed in our practice beyond addressing language preferences. Absence of health literacy screening and complex social challenges are a few of the threats to our patients’ diabetes self- management. Additionally, most of our physicians are international medical graduates that have varying understanding of health literacy.


To improve diabetes self-management through health care literacy assessment tools and matched educational materials.


The stakeholders were clinic residents, attendings, staff, clinic director and patients. Process mapping and a fishbone diagram were created for problem analysis and intervention formulation. A retrospective chart review was performed to understand patient demographics – language preference, educational level, diabetes control through HBA1c and physicians’ Electronic Medical Record (EMR) utilization of educational handouts. Educational materials were obtained with permission from the PRIDE study. For PDSA 1, a health literacy supportive environment was established in clinic. Physician education through lectures and online video learning was given. For PDSA 2, patient print out materials were made available to encourage patient-initiated conversation about diabetes care. A health literacy screening dot phrase standardized physician assessment. A comprehensive diabetes care dot phrase was used to mirror patient flyers to allow physicians and patients to engage in the same conversation. A pre and post survey for physician understanding of health literacy was performed for PDSA 1. Percentage of patients that had health literacy screening, comprehensive DM management discussion and use of educational packets were checked with all cycles.


The pre and post survey for physicians after receiving educational intervention, showed improved confidence in managing patients with health literacy needs, an expanded definition of health literacy to include numerical literacy important in diabetes. After PDSA 2, health literacy screening improved from 0% to 35%, use of educational materials improved from 15-35% and items such as exercise and nutrition counseling were observed more frequently in documented patient plans. Patients reported fair to good satisfaction in diabetes care discussion. We also found that 100% of those screened preferred reading and viewing pictures as methods of learning rather than only receiving verbal discussions. Only 10% of physician residents used the comprehensive diabetes care dot phrase.


An EMR-deliverable standard tool for screening health literacy is an efficient way for physicians to improve awareness of health literacy needs. The short PDSA cycles have  shown improvement in the number of patients screened for health literacy and uncovered specific learning styles in our patients. Additional are needed to identify logistical challenges that limit uniform use of the dot phrases and to study the clinical benefits of patient engagement. Take-home educational material improves patient satisfaction.

Clinical Implications

Numerous studies have shown a positive correlation between health literacy and diabetes knowledge affecting diabetes management. (3). The availability of digital platforms should be maximized in assisting healthcare providers in managing patients with limited health literacy needs.

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