Members of the North Carolina Program on Health Literacy have significant experience in the development of literacy-sensitive health education materials. Several of these health communication aids, available for use in clinic and research settings, are detailed below.
Researchers at UNC have studied the design and implementation of heart failure self-management support and performed clinical trials demonstrating that organized self-management support can improve self-care behaviors and prevent hospitalizations.
In 2006, the team at UNC, in collaboration with partners at San Francisco General Hospital and Northwestern Feinberg School of Medicine, revised the materials for a multi-center clinical trial funded by the National Heart, Lung, and Blood Institute. The original and revised materials resulted from input from patients, nurses, cardiologists, internists, nutritionists, pharmacists, and health literacy experts.
The revised materials are available in two versions, currently being tested in a multi-center clinical trial. The versions are identical except for one aspect. Version 1 does not teach patients how to self-adjust their diuretic dose based on daily weights. Rather, it instructs patients to call their clinician if the weight changes by a certain amount. Version 2 teaches patients to adjust their diuretic dose based on daily weights. Version 2 advises the patient to notify the clinician for sustained or substantial weight changes. Version 2 also comes with a water pill guide that the patient can keep out to remind them of the correct dosing, as well as a weight chart for patients to keep track of their daily weights.
Guidelines for how we used Caring for Your Heart patient educational materials in clinical trials:
DeWalt DA, Pignone M, Malone R, Rawls C, Kosnar MC, George G, Bryant B, Rothman RL, Angel B. Development and pilot testing of a disease management program for low literacy patients with heart failure. Patient Educ Couns. 2004 Oct;55(1):78-86.
DeWalt DA, Malone RM, Bryant ME, Kosnar MC, Corr KE, Rothman RL, Sueta CA, Pignone MP. A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170]. BMC Health Serv Res. 2006
In 2005, researchers at UNC, the University of California at San Francisco, and Louisiana State University collaborated to develop a comprehensive self-care guide for patients living with diabetes. The patient-provider tool was issued in a conversational and easy-to-read magazine format and places heavy emphasis on action – what patients need to do each day to manage their diabetes – rather than on an exchange of information. The guide resulted from input from patients, nurses, diabetes educators, internists, nutritionists, pharmacists, and health literacy experts. It is available in both English and Spanish versions and is currently being used in clinical and research settings in multiple states.
Diabetes Self-Management materials are available in English at:
Heart-failure patients take their medicine more reliably when under the care of a pharmacist, resulting in fewer emergency-room visits and hospital stays and lower health-care costs, according to a study led by Michael D. Murray, PhD, the Mescal S. Ferguson Distinguished Professor at the School.
According to the American Heart Association, more than five million people in the United States are in various stages of heart failure with total health-care costs exceeding $29 billion. The study, published in the June 2007 issue of the Annals of Internal Medicine, studied 314 low-income patients with heart failure. The participants were randomized to receive standard services from a pharmacist, and the others received care from a specially trained pharmacist who had access to customized educational materials, provided comprehensive instruction to participants, and reminded them to refill their prescriptions. The study not only improved the way patients took their pills and reduced the rate at which their heart failure worsened, it also had impressive cost savings.
Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, Stroupe KT, Wu J, Clark D, Smith F, Gradus-Pizlo I, Weinberger M, Brater DC. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007 May;146(10):714-25.
The Diabetes Literacy and Numeracy Education Toolkit (DLNET) was designed to aid in the education and self-management of patients with Type 1 or Type 2 Diabetes regardless of their current medical regimen or health status.
Developed by a team led by Russell Rothman at Vanderbilt, the DLNET has been broken down into individual modules so that education can be customized to each patient. To avoid overwhelming patients with too much information, it is recommended that providers give patients the modules as they are needed. An emphasis is placed on limiting information to just the key concepts or behaviors needed for improved self-management.
The toolkit includes over 24 chapters that can used in educating patients with diabetes - particularly those with poor literacy or numeracy skills. Materials, including the guide, and a provider’s instruction manual can be downloaded at the Vanderbilt Diabetes Research and Training Center.
DLNET materials are available in English at:
UNC researchers led initiatives to create literacy-sensitive materials related to COPD. The COPD self-management guide, Living with COPD: An Everyday Guide for You and Your Family covers areas such as living well with COPD, getting the most out of your medicines, becoming more active, and planning for when your breathing gets worse.
Living with COPD: An Everyday Guide for You and Your Family is available in English from: