Development of educational materials for diabetic patients with low literacy: involving the stakeholders in production

Abstract

BACKGROUND: Health literacy (HL) is one of the core competences that a person should possess in order to navigate the health care system and gain most from health promotion activities. However, individuals‟ HL level has seldom been addressed in health promotion in Chinese society. OBJECTIVES: This paper aims to report 1) the development process of educational materials that target to motivate diabetic older adults‟ engagement in physical activity; 2) how 23 older adults‟ comments and social values were incorporated in the production of the materials and 3) how individual’s health literacy level was addressed in health promotion. UNDERLYING VALUES AND PRINCIPLES: Attention was given to the attributes of effective health communication, which was advocated by Healthy People 2010 when designing the educational materials. Involvement of stakeholders in the production ensures the understandability of the health messages that suits the need of older adults. KNOWLEDGE BASE/ EVIDENCE BASE: Qualitative data was collected in the 56 cognitive interviews and these evidences enhanced the current practice of developing health educational materials to the public. CONTEXT OF INTERVENTION/PROJECT/WORK: Two educational materials which include a pictorial storybook with 8-week worksheets and a 6-part audiotape were developed. These materials targeted to motivate diabetic older adults to engage in regular walking exercise and muscle strengthening exercise. Most of the older adults in Hong Kong were illiterate or of low educational level. METHODS: Twenty-three adults aged 65 or above, with type 2 diabetes mellitus and were able to communicate in Cantonese, were recruited. A total of 56 cognitive interviews (using read aloud method) were completed. The contents were transcribed and common themes were identified. RESULTS AND CONCLUSIONS: In the interviews of the pictorial storybook, informants commented on the flow of the story, the design of the pictures, and practicality of the contents of the story. The gaps between pictures were identified. Informants also expressed their interests to the use of stickers when reporting their health activities and their supporters to health behaviour. In the interviews of the audiotapes, informants commented on the flow of the conversation, the clarity of messages and the tone of the voices. The above findings were useful to improve the quality of the educational materials. The involvement of older adults, who are the stakeholders, in the development of educational materials enriched the contents of the storybook and increased the possibility of adapting these materials in diabetic care. The current study is of significant importance to contribute to health promotion in Chinese society.