Effects of Patient Empowerment and Health Literacy on Blood Pressure Control in Patients with Type 2 Diabetes at Grady Hospital Pubblico
Roberson, Lara Lindsay (2011)
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
- LITERATURE REVIEW
-
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
About this Master's Thesis
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