University of Arkansas
The researchers will conduct a patient-randomized, pragmatic clinical trial among 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes. The primary aims are to: 1. test the effectiveness of the ACP diabetes health literacy intervention to improve a range of diabetes-related outcomes among rural patients; 2. compared to usual care, evaluate whether the intervention reduces disparities by patient literacy level. The secondary aims are to: 3. investigate whether a threshold or gradient effect exists between the amount of follow-up counseling (number of action plans) and intervention effectiveness; 4. determine the fidelity of all intervention components, and explore any identified patient, provider (physician, nurse, health coach), and/or health system barriers to implementation; and 5. assess the costs associated with implementing the intervention from a health system perspective.
Diabetes
ACP Living with Diabetes Guide
ADA Living Well with Diabetes Workbook
NA
The investigators will test the effectiveness and fidelity of embedding the American College of Physicians (ACP) diabetes health literacy intervention among patient-centered medical homes throughout rural Arkansas. Proper diabetes self-care requires patients to have considerable knowledge, a range of skills, and to sustain multiple health behaviors. Self-management interventions are needed that have been designed for individuals with lower literacy skills, that can be readily implemented and sustained among rural clinics with limited resources that disproportionately care for patients with limited literacy. Researchers on the team developed an evidence-based, patient-centered, low literacy ACP intervention promoting diabetes self-care that includes: 1. a diabetes guide that uses plain language and descriptive photographs to teach core diabetes concepts and empower patients to initiate behavior change; 2. a brief counseling strategy to assist patients in developing short-term, explicit and attainable goals for behavior change ('action plans'); 3. a training module for physicians, nurses, and medical assistants that prepares providers to assume educator/counselor roles with the Diabetes Guide as a teaching tool; 4. electronic tracking and monitoring tools for primary care practices. While the intervention has previously been field tested and found to significantly improve patient knowledge, self-efficacy, and engagement in related health behaviors, it has not yet been comprehensively tested in practices, and its optimal implementation is not known. The investigators now have a unique opportunity to learn from prior evaluation, modify and disseminate an ACP health literacy intervention among patients with type 2 diabetes cared at rural clinics in Arkansas that are Patient-Centered Medical Homes (PCMH). These practices are embedding care coordination services that can be leveraged to improve chronic disease management. All are supervised by a new University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy. The investigators' revised intervention will blend outsourced and clinic-based approaches and redeploy health coaches for counseling self-management mostly via phone, but also at the point-of-care. This is a feasible way to reach rural, vulnerable patients. The investigators will conduct a patient-randomized, pragmatic clinical trial among 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes. The primary aims are to: 1. test the effectiveness of the ACP diabetes health literacy intervention to improve a range of diabetes-related outcomes among rural patients; 2. compared to usual care, evaluate whether the intervention reduces disparities by patient literacy level. The secondary aims are to: 3. investigate whether a threshold or gradient effect exists between the amount of follow-up counseling (number of action plans) and intervention effectiveness; 4. determine the fidelity of all intervention components, and explore any identified patient, provider (physician, nurse, health coach), and/or health system barriers to implementation; and 5. assess the costs associated with implementing the intervention from a health system perspective.
| Study Type : | INTERVENTIONAL |
| Estimated Enrollment : | 756 participants |
| Masking : | NONE |
| Primary Purpose : | TREATMENT |
| Official Title : | Health Literacy Intervention to Improve Diabetes Outcomes Among Rural Primary Care Patients |
| Actual Study Start Date : | 2016-11-07 |
| Estimated Primary Completion Date : | 2020-02-12 |
| Estimated Study Completion Date : | 2020-02-12 |
Information not available for Arms and Intervention/treatment
| Ages Eligible for Study: | 21 Years |
| Sexes Eligible for Study: | ALL |
| Accepts Healthy Volunteers: | 1 |
Want to participate in this study, select a site at your convenience, send yourself email to get contact details and prescreening steps.
Not yet recruiting
UAMS Family Medical Center Northwest
Fayetteville, arkansas, United States, 72703
Not yet recruiting
UAMS Family Medical Center Fort Smith
Fort Smith, arkansas, United States, 72901
Not yet recruiting
UAMS Family Medical Center Jonesboro
Jonesboro, arkansas, United States, 72401
Not yet recruiting
UAMS Family Medical Center Magnolia
Magnolia, arkansas, United States, 71753
Not yet recruiting
UAMS Family Medical Center Pine Bluff
Pine Bluff, arkansas, United States, 71603
Not yet recruiting
UAMS Family Medical Center Texarkana
Texarkana, arkansas, United States, 71854