Background: Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making. Health literacy provides an additional, potentially powerful explanatory framework to guide research and practice.
Objective: To examine the changes in the depth and detail of diabetes-related knowledge and confidence for persons with type 2 diabetes.
Design: Two-year, prospective, observational study, using questionnaire data at two time points (baseline and 2 years later) and in-depth interviews with a theoretically selected subsample.
Setting and participants: A total of 319 patients initially recruited from a deprived urban area in north-west England.
Intervention: Dedicated tele-carer education and support, tailored to the individual circumstances of the patient.
Main outcome measures: Perceptions of confidence, levels of empowerment, learning for self-care and most helpful aspects of the intervention.
Results: Over 90% expressed confidence in keeping their blood sugar controlled, and high levels of perceived empowerment (mean = 4.25; 95% CI, 4.17-4.33) were found. Changes in the depth and detail of diabetes-related knowledge and confidence, from the specific to the more general, were observed and enhanced competence in translating knowledge into practice.
Discussion and conclusions: The intervention, built within a developed working partnership between tele-carer and patient, operated at two levels: health literacy, enhancing knowledge, developing personal skills and enabling self-control; and socio-psychological behavioural change, tailored to individuals within their socio-economic environments, enabling increased motivation and supportive problem-solving. Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data.
© 2011 Blackwell Publishing Ltd.