Building Competency in Diabetes Education THE ESSENTIALS

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require a good understanding of numerical concepts. These skills include reading numbers on a meter, carbohydrate counting, pattern management, pump use, insulin dose adjustments and label reading. The result is that people may guess their way through educational interactions, read so slowly that they miss the context and come to the wrong conclusion, transpose numbers incorrectly or see only one part of the number. They may find it difficult to ask questions, clarify or self direct the process. Fear and embarrassment are often the result (68-71). Strategies to assist in low health literacy The literature suggests the use of the following strategies to counter lower literacy (70-73): • Use more person-to-person interaction and adjust teaching time. • Use open-ended questions. • Use care in word selection and minimize the use of complex sentences. • Use visual aids and concrete examples. • Start discussions with the most important points. • When sequencing instruction, repeat main concepts, limit the number of main concepts and highlight main concepts in more than one way/medium. • Use summaries, tailor written messages to the individual and personalize them (with markers to highlight, add name, etc.). • Ask patients to “teach-back” or restate information. • Use tools for determining reading level, such as those provided by most computer programs (word count and readability statistics), Fry’s Readability Graph (74) or the SMOG grading formula (75). The computer-generated readability or SMOG index are commonly used tools to assess readability level, although educators should be cautious about relying on readability formulas, especially computer-generated ones, to the exclusion of a common-sense analysis of context and familiarity with the words, etc. (76). To use the SMOG formula manually: o Count 10 consecutive sentences near the beginning, middle and end of the material (total = 30 sentences). A sentence is any list of words ending in a period, question or exclamation point. o Count every word of three or more syllables in the 30 sentences. If a word is repeated, count the repetition also.