Health Literacy Intervention for African Americans With Diabetes

The Literacy Assessment in Diabetes (LAD) has high reliability and validity indices. The items on the LAD are scored as correct/incorrect, with total possible scores ranging from 0 to 60. Higher scores indicated higher health literacy levels.

The Newest Vital Sign consists of four items and measures numeracy. After reviewing a nutrition label, participants are asked to answer questions based on some calculation of the nutritional information (e.g., fat, sodium) presented on the label. Total possible scores range from 0 to 4, with one point assigned for each correct response.

The Diabetes Knowledge Test assesses diabetes knowledge, medications, diet, and management with questions such as "What effect will an infection most likely have on blood glucose." Correct responses are given a score of one.

The Stanford Diabetes Self-Efficacy scale assesses participant's efficacy in managing diabetes and maintaining healthy lifestyles. The scale asks how confident participants are in managing different tasks such as eating meals every 4 to 5 hours every day or breakfast every day measured on a Likert scale of 0 "not at all confident" to 10 "totally confident." Participant scores are the means across all items in the instrument.

This index included seven questions on smoking, alcohol consumption, meal planning, consumption of high fat foods, consumption of high sugar foods, consumption of sodium, and medium or high intensity exercise. These questions were coded into dichotomous responses with participation in healthy behaviors coded as "1" and active participation in negative health behaviors coded as "0". A summary score for the index could range 0-7 and higher scores indicate better self-care.

mMOS-SS is a shorter version (10 items) of the Medical Outcomes Study-Social Support Survey (MOS-SS) which includes 19 items. The original version was used to measure social support in community dwelling chronically ill persons. mMOS-SS covers emotional and instrumental domains of social support with strong evidence of reliability and validity. Example items include: "How often is someone available to take you to the doctor if you need it" or "How often is someone available who understands your problems?" Response options are from all of the time (5 point) to none of the time (1 point) with higher scores indicating higher levels of social support (total score range=10 to 50).

The Patient Health Questionnaire (PHQ)-9 addresses the severity of depressive symptoms based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The PHQ-9 has 9 items scored from 0 (not at all) to 3 (nearly every day) with total scores ranging from 0 to 27. Individuals are asked whether any symptom(s) have been experienced over the past 2 weeks. Evidence of reliability, validity, sensitivity, and specificity has been reported in community samples.

It contains the EQ-5D-3L that provides a single index of health status. The EQ-5D-3L assess five domains; mobility, self-care, usual activities, pain/discomfort and anxiety/depressions. Responses show if participants do not have difficulty, have some problems or have severe difficulty within the domains. Summary scores for the sample were created across each of the five items (range 0-2) with higher scores indicating better quality of life. A component of this scale is the EuroQol visual analogue scale (EQ-VAS) which participants can use a number from 0-100 to identify participant's health state.