From the Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (DK); Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA (DHS, MBP).
J Am Board Fam Med. 2024 Mar-Apr;37(2):303-308. doi: 10.3122/jabfm.2023.230324R1.
Previous research has found an association between low health literacy and poor clinical outcomes in type 2 Diabetes Mellitus (T2DM) patients. We sought to determine if this association can be mitigated by a self-management support (SMS) program provided by trained health workers using a technology assisted menu driven program, called Connection to Health (CTH).
This study is a secondary analysis from a randomized trial of 2 similar versions of CTH implemented in 12 Northern California community health centers. As part of this, each participant completed a single validated question to assess health literacy. We used unadjusted and adjusted linear regression analyses to determine the extent to which baseline health literacy was predictive of prepost changes in hemoglobin A1c (HbA1c).
Of 365 participants for whom prepost HbA1c data were available, HbA1c concentrations declined by an average of 0.76% (from 9.9% to 9.2%, 95% CI (0.53%-1.0%). Almost 114 (31.2%) of the participants had low health literacy, but there was no significant association between health literacy and the reduction in HbA1c concentrations in either the unadjusted or adjusted models, nor did baseline health literacy predict prepost changes in body mass index, medication adherence, exercise, or diet.
The study found that implementing the CTH program in 2 versions via a randomized clinical trial improved HbA1c concentrations without increasing disparities between participants with high and low health literacy. This suggests CTH-like programs can enhance diabetes outcomes in community health centers without exacerbating inequities for those with low health literacy.
先前的研究发现，2 型糖尿病（T2DM）患者的健康素养水平较低与临床结局较差之间存在关联。我们试图确定，通过由经过培训的卫生工作者使用一种名为“Connection to Health”（CTH）的技术辅助菜单驱动程序提供的自我管理支持（SMS）计划，是否可以减轻这种关联。
本研究是在加利福尼亚州北部 12 个社区卫生中心实施的两种类似 CTH 版本的随机试验的二次分析。在此过程中，每位参与者都完成了一个单一的验证问题来评估健康素养。我们使用未调整和调整后的线性回归分析来确定基线健康素养在多大程度上预测血红蛋白 A1c（HbA1c）的前后变化。
在可获得前后 HbA1c 数据的 365 名参与者中，HbA1c 浓度平均下降了 0.76%（从 9.9%降至 9.2%，95%CI（0.53%-1.0%）。几乎有 114 名（31.2%）参与者的健康素养较低，但在未调整或调整后的模型中，健康素养与 HbA1c 浓度降低之间均无显著关联，基线健康素养也不能预测前后体重指数、药物依从性、运动或饮食的变化。
该研究发现，通过随机临床试验实施两种版本的 CTH 方案可以改善 HbA1c 浓度，而不会加剧高健康素养和低健康素养参与者之间的差距。这表明，类似于 CTH 的计划可以增强社区卫生中心的糖尿病治疗效果，而不会加剧那些健康素养较低的人群的不平等现象。
