Correlates of vitamin D insufficiency in an affluent adult population.

OBJECTIVES: Vitamin D is necessary for bone health and calcium metabolism. Vitamin D deficiency may play a role in coronary artery disease, some cancers, autoimmune disease, and glucose tolerance. Vitamin D deficiency may be prevalent even among affluent US adults. METHODS: We conducted a retrospective chart review study of 287 adult patients who underwent executive physical examinations between April 2009 and May 2010 in Chicago, Illinois. Data collected included age, sex, body mass index, vitamin D levels, supplement use, fish consumption, milk consumption, hours spent outdoors, and sunscreen use. Vitamin D insufficiency was defined as <30 ng/mL. RESULTS: The mean vitamin D level was 40.0 ng/mL (standard deviation 16.6), which varied by month. The mean vitamin D level ranged from 32.9 ng/mL in January to 55.4 ng/mL in September. Insufficient levels of vitamin D were observed in 30.3% of patients. Younger age (younger than 40 years); no milk or fish consumption; no use of multivitamins, vitamin D supplements, or calcium supplements; no sun exposure; and routine use of sunscreens were positively associated with vitamin D insufficiency. CONCLUSION: Vitamin D insufficiency in almost one-third of patients presenting for executive physicals may be indicative of a widespread nutritional deficiency in the US population.

Literacy and retention of information after a multimedia diabetes education program and teach-back.

Few studies have examined the effectiveness of teaching strategies to improve patients' recall and retention of information. As a next step in implementing a literacy-appropriate, multimedia diabetes education program (MDEP), the present study reports the results of two experiments designed to answer (a) how much knowledge is retained 2 weeks after viewing the MDEP, (b) does knowledge retention differ across literacy levels, and (c) does adding a teach-back protocol after the MDEP improve knowledge retention at 2-weeks' follow-up? In Experiment 1, adult primary care patients (n = 113) watched the MDEP and answered knowledge-based questions about diabetes before and after viewing the MDEP. Two weeks later, participants completed the knowledge assessment a third time. Methods and procedures for Experiment 2 (n = 58) were exactly the same, except that if participants answered a question incorrectly after watching the MDEP, they received teach-back, wherein the information was reviewed and the question was asked again, up to two times. Two weeks later, Experiment 2 participants completed the knowledge assessment again. Literacy was measured using the S-TOFHLA. After 2 weeks, all participants, regardless of their literacy levels, forgot approximately half the new information they had learned from the MDEP. In regression models, adding a teach-back protocol did not improve knowledge retention among participants and literacy was not associated with knowledge retention at 2 weeks. Health education interventions must incorporate strategies that can improve retention of health information and actively engage patients in long-term learning.

The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program.

OBJECTIVE: Multimedia diabetes education programs (MDEP) have the potential to improve communication and education of those with low health literacy. We examined the effect of a MDEP targeted to patients with low literacy on knowledge and assessed the association between literacy and knowledge improvement. METHODS: We showed the MDEP to 190 patients recruited from clinics at a federally qualified health center and an academic health center. We measured diabetes knowledge before and after viewing the MDEP. RESULTS: Seventy-nine percent of patients had adequate literacy, 13% marginal, and 8% inadequate literacy. Patients across all literacy levels had significant increases in knowledge scores after viewing the MDEP (p-value<0.001). Patients with inadequate literacy learned significantly less after the MDEP (adjusted beta-coefficient=-2.3, SE=0.70) compared to those with adequate literacy. CONCLUSIONS: A MDEP designed for those with low literacy significantly increased diabetes knowledge across literacy levels. However, the MDEP did not overcome the learning gap between patients with low and high literacy. PRACTICE IMPLICATIONS: A literacy appropriate MDEP may be an effective way to teach patients about diabetes. Combining the MDEP with other education methods may improve comprehension and learning among those with low literacy. Research is needed to identify which characteristics of low-literate patients influence the ability to learn health information. Identifying these factors and incorporating solutions into a diabetes education intervention may help bridge the learning gap related to literacy status.