Improving Diabetes Health Literacy by Animation

To produce a Spanish/English animated video about diabetes; to qualitatively assess cultural and linguistic appropriateness; and to test effectiveness at improving diabetes health literacy among Latino/Hispanics.

Participatory research and animation production methods guided development of the video. Cultural appropriateness was assessed through focused discussion group methods. A prospective randomized controlled trial tested the effectiveness of the Spanish version at improving diabetes health literacy, compared to "easy to read" diabetes information from the National Institute of Diabetes and Digestive and Kidney Diseases. Functional health literacy was measured by the Short Test of Functional Health Literacy in Adults. Diabetes health literacy was measured by the Diabetes Health Literacy Survey (DHLS).

No significant differences were recorded between experimental (n = 118) and control groups (n = 122) at baseline on demographic characteristics, Short Test of Functional Health Literacy in Adults score, or DHLS score. Fifty-eight percent of the study participants had inadequate functional health literacy. Mean DHLS score for all participants and those having adequate functional health literacy were 0.55 and 0.54, respectively (inadequate diabetes health literacy). When adjusting for baseline DHLS score, sex, age, and insurance status, DHLS scores improved significantly more in the experimental group than the control group (adjusted mean = 55% vs 53%, F = 4.7, df = 1, P = .03). Interaction between experimental group and health literacy level was significant (F = 6.37, df = 2, P = .002), but the experimental effect was significant only for participants with inadequate health literacy (P = .009).

The positive effect on DHLS scores suggests that animation has great potential for improving diabetes health literacy among Latinos having limited functional health literacy. A study is needed that targets participants with inadequate health literacy and that uses the English and Spanish versions of the video.