A QUALITY IMPROVEMENT PROJECT: ENHANCING PATIENT COMPREHENSION AND WILLINGNESS TO CHANGE FOLLOWING PREDIABETES EDUCATION

Abstract

Problem: Prediabetes is an increasingly prevalent condition, involving the recognition of elevated blood glucose levels through a diagnostic hemoglobin A1C reading between 5.7% and 6.4%; if left unaddressed, severe complications may occur (American Diabetes Association [ADA], 2016; Menke, Casagrande, Geiss & Cowie, 2015). While research has shown that successful incorporation of the lifestyle modifications of diet and exercise can lower the risk for these complications by up to 58%, the utilization of beneficial modifications has not been reported by all of those with this condition (ADA, 2016; Dorsey & Songer, 2011). Project Aim: The purpose of this project was to distinguish if newly diagnosed adults with prediabetes who were provided with both verbal and written education, compared to those who only received verbal education, would experience an improved retention of information regarding necessary lifestyle modifications, and demonstrate a willingness to change in a one-month follow-up survey. Project Method: The theoretical framework for this project is the Transtheoretical Model of behavior change (Prochaska & Velicer, 1997). The project took place across four local, urban primary care clinics. Participants were separated into two groups at the time of agreeing to project involvement using consecutive assignment. Group A received verbal instructions from their healthcare provider regarding prediabetes, and then participated in a teach-back session with the DNP student to further review the ADA’s (2016) recommendations for lifestyle modifications. Group B received the same verbal education, but was also provided with an educational leaflet from the ADA (2016) during their teach-back session. Research has shown that more than half of the education patients receive during office visits is either forgotten or incorrect (AHRQ, 2015). To enhance knowledge retention, emphasis was placed on utilizing the validated Teach Back Method (AHRQ, 2015) for all participants. One-month Likert scale follow-up surveys were electronically delivered to all participants for evaluation and assessment of the project’s outcomes. Project Findings: Follow-up surveys were sent electronically to the 13 project participants, 12 completed surveys were returned. Data were gathered and analyzed. The Mann Whitney U Test (Wilcoxon Rank Sum Test) was used to calculate statistical significance (p=<0.05). Significant improvement was noted with Group B’s responses to how often they felt the verbal instructions they received regarding their condition were easy to understand (U=5, p<0.0455). Significant findings were also noted with Group B’s responses quantifying how often anyone in their healthcare practice asked them to describe how they were going to follow their specific health instructions (U= 3.5, p<0.0251). There were no significant findings seen in the prediabetes management portion of the electronic survey: overall feeling well managing prediabetes (p=0.689), would like to do better with exercising (p=0.873), would like to improve with eating better foods (p=0.749), currently doing well with exercising (p=0.749), currently doing well with eating better foods (p=0.936). No significance was noted on the last health literacy question in the electronic survey regarding how often participants felt their health care providers and staff had spent time with them (p=0.093). Conclusion: Including written materials, along with verbal instruction, regarding the new diagnosis of prediabetes and necessary lifestyle modifications can improve ease of patient learning and foster opportunities for health care workers to utilize the validated teach-back method. Further research is recommended to evaluate the relationship between verbal and written education and retention of prediabetes management instruction and willingness to change by incorporating recommended lifestyle modifications.