Effects of Patient Empowerment and Health Literacy on Blood Pressure Control in Patients with Type 2 Diabetes at Grady Hospital Public

Roberson, Lara Lindsay (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/mw22v5716?locale=fr
Published

Abstract


BACKGROUND: Patient empowerment is seen as a key tool to increasing patients'
application of their knowledge and participation in health care processes. Few
studies have examined the influence of short-term increases in patient knowledge
on clinical outcomes and whether baseline health literacy modifies this relationship.
OBJECTIVE: To investigate the effects of a patient empowerment intervention (and
baseline health literacy) on hypertension and cardiovascular risk factor control in
an underserved minority population with type 2 diabetes.
DESIGN: Randomized control ed trial
INTERVENTION: Individuals randomized to the intervention received coaching
sessions (a "roadmap" discussing past BP trends, goals, and personalized feedback)
at each outpatient clinic visit while control arm patients received usual care.
PARTICIPANTS: 296 regular clinic-attendees (149 controls, 147 intervention
subjects) with type 2 diabetes were included in this study analysis.
MAIN MEASURES: Clinical (systolic blood pressure (SBP), diastolic blood pressure
(DBP), glycated hemoglobin (HbA1C), lipid profile) and knowledge (Patient
knowledge of diabetes, perceived exercise barriers, and better awareness of long-
term care benefits) data were measured at baseline and at last recorded visit. Health
literacy was measured at 6-month follow-up.
RESULTS: Participants were predominantly older (mean age: 58.5 ± 9.9), female
(72.6%), African American (96.3%), non-working (83.0%), on government
insurance (26.0%) or uninsured (21.62%), poor (56.4%), and un-married (77.8%).
Among intervention and control group participants, SPB decreased over the in-trial
period by a mean of 13.23 mmHg (±29.42) (p=0.0003) and 12. 22 mmHg (±31.86)
(p=0.0015), respectively. Significant DBP reductions between pre- and post-
intervention levels were also observed in both groups (-6.46±20.76 and -
4.37±18.94) (p<0.05 for both). There were no significant between-group differences
in blood pressure change. We observed no significant changes in knowledge,
reported exercise barriers, and recognition of long-term benefit scores (p>0.05) in
either treatment group. Baseline health literacy did not significantly mitigate the
intervention effect in the analysis (p=0.9889).
CONCLUSIONS: Patient empowerment interventions may have short-term benefits.
However, further studies will be needed to determine whether benefits are
sustained, and the specific mechanisms that are responsible.

Table of Contents

  • CHAPTER 1
    • LITERATURE REVIEW
      • Epidemiology of Diabetes
      • Diabetes Self-Management Education
      • Health Literacy
  • CHAPTER 2
    • ABSTRACT
    • INTRODUCTION
    • METHODS
      • Null Hypothesis
      • Setting and Study Participants
        • Inclusion Criteria
        • Exclusion Criteria
      • Measures
        • Primary Outcomes
        • Secondary Outcomes
        • Covariates
      • Statistical Analysis
    • RESULTS
      • Participant Characteristics
      • Treatment Effect on Clinical and Behavioral Outcomes
      • Potential Mediators of Intervention Effect on Systolic Blood Pressure
    • DISCUSSION
      • The Primary Intervention
      • Health Literacy
      • Loss to Follow-up
      • Strengths and Limitations
        • Strengths
        • Limitations
      • Summary
    • REFERENCES
    • FIGURES
      • Figure 1
    • TABLES
      • Table 1
      • Table 2A
      • Table 2B
      • Table 2C
      • Table 3A
      • Table 3B
      • Table 4
  • CHAPTER 3
    • PUBLIC HEALTH IMPLICATIONS
    • APPENDIX
      • Example of Survey
      • Intervention Blood Pressure Road Map

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