Can Health Literacy Be Improved by a Short-Term Intervention?: An Intervention to Improve Health Literacy in Korean-American Immigrants with Type 2 Diabetes Mellitus

Monday, 30 July 2012: 11:30 AM

Miyong T. Kim, RN, PhD, FAAN
Hae-Ra Han, RN, PhD, FAAN
Tam Hieu Nguyen, RN, MSN/MPH
School of Nursing, The Johns Hopkins University, Baltimore, MD


The purpose of this study is to test the efficacy of a relatively short-term DM specific health literacy (HL) education intervention in improving health literacy and other relevant psycho- behavioral outcomes among a sample of Korean American immigrants (KAI) with type 2 diabetes mellitus (DM).


A randomized pilot trial tested a DM specific HL intervention for KAI with type 2 diabetes mellitus. The intervention consists with 6 x 2 group educations focus on activities to promote both print and functional literacy levels.  Print literacy was measured using a modified version of the Rapid Estimates of Adult Literacy in Medicine (REALM). Functional literacy was measured using a modified version of   the Test of Functional HL in Adults (TOFLHA) and the Newest Vital Signs. A series of analyses of covariance was performed to compare changes in study outcomes between groups, after controlling for baseline differences.


A total of 79 KAIs (intervention n=40, control n=39) completed the baseline evaluation and the 18-week and 30-week follow-ups. The sample included about an equal number of males and females, had resided in the US for more than 10 years (77%), although more than two-thirds (67.5%) indicated that they were not able to finish hospital appointments without an interpreter. The final analysis showed significantly improved scores for both print (p=0.05) and functional literacy levels (P=0.00) at the 30-week follow-up. Evaluation of other related outcomes also revealed positive results: as compared to the control group, the intervention group showed significant improvement in DM knowledge, DM-related self-efficacy, self-care activities and reduction of more than 1% in HbA1C levels.


The intervention improved HLs, as well as psychosocial and behavioral outcomes. The level of HL can serve as a missing link between individual characteristics, psychosocial variables, and chronic disease management, particularly among immigrant populations.