title: Enhancing health literacy and behavioural change within a tele-care education and support intervention for people with type 2 diabetes.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  A total of 319 patients initially recruited from a deprived urban area in north-west England.
  
  
  METHODS
  Dedicated tele-carer education and support, tailored to the individual circumstances of the patient.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK. a.f.long@leeds.ac.uk
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Long
authors.forename: Tina
authors.initials: T
authors.lastname: Gambling
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D004032:Diet; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic / Q000379:methods; D011446:Prospective Studies; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D013689:Telephone
chemical_list: D006442:Glycated Hemoglobin