The Feasibility of Health Trainer Improved Patient Self-Management in Patients with Low Health Literacy and Poorly Controlled Diabetes: A Pilot Randomised Controlled Trial.
Type 2 diabetes mellitus is most prevalent in deprived communities and patients with low health literacy have worse glycaemic control and higher rates of diabetic complications. However, recruitment from this patient population into intervention trials is highly challenging. We conducted a study to explore the feasibility of recruitment and to assess the effect of a lay health trainer intervention, in patients with low health literacy and poorly controlled diabetes from a socioeconomically disadvantaged population, compared with usual care.Methods. A pilot RCT comparing the LHT intervention with usual care. Patients with HbA1c > 7.5 (58 mmol/mol) were recruited. Baseline and 7-month outcome data were entered directly onto a laptop to reduce patient burden.Results. 76 patients were recruited; 60.5% had low health literacy and 75% were from the most deprived areas of England. Participants in the LHT arm had significantly improved mental health (p= 0.049) and illness perception (p= 0.040). The intervention was associated with lower resource use, better patient self-care management, and better QALY profile at 7-month follow-up.Conclusion. This study describes successful recruitment strategies for hard-to-reach populations. Further research is warranted for this cost-effective, relatively low-cost intervention for a population currently suffering a disproportionate burden of diabetes, to demonstrate its sustained impact on treatment effects, health, and health inequalities.
Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.
Joanne
0000-0002-9608-1487
J
Protheroe
Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.
Trishna
T
Rathod
Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.
Bernadette
0000-0002-8557-6222
B
Bartlam
Section for Health Promotion and Health Services, Institute for Public Health, Aarhus University, Aarhus, Denmark; Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK.
Gillian
G
Rowlands
Centre for Health Economics, University of York, York, UK.
Gerry
G
Richardson
Centre for Primary Care and Centre for Biostatistics, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
David
D
Reeves
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000628:therapy*; D004739:England; D005240:Feasibility Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D057220:Health Literacy; D006282:Health Personnel; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010379:Peer Group; D010865:Pilot Projects; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000379:methods*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human