Improving health numeracy: utilizing objective parameters to improve shared decision making for insulin initiation
S. Kalra1, N. Agrawal2 & B. Kalra1
Background: Health numeracy is the ability to understand, and act upon quantitative data, in an appropriate and effective manner. Health numeracy is distinct from health literacy. Health numeracy is associated with better self-management.
Aims and objectives: This study was performed at two endocrine centres in north India, to assess and improve the health numeracy of patients with type 2 diabetes, with an aim to improving the quality of shared decision making (SDM).
Material and methods: A three months long campaign was begun to explain the meaning of HbA1c, vibration perception threshold and mean plasma glucose to 1000 patients presenting with T2DM in the OPD. This study was carried out by laboratory technologists, by means of semi-structured training, at each OPD visit.
Results: At baseline, 24.5, 11.8 and 45.0% of patients understood the meaning of HbA1c, mean vibration perception threshold (VPT) and mean plasma glucose (MPG) respectively. At three months, these proportions had increased to 56.6, 90.0 and 67.3% respectively.
During these three months, 351 patients were initiated on various regimes of insulin, of which 250 consented to fill a pre structured questionnaire. 60.0% of them felt that understanding their HbA1c value had played a major role in motivating them to begin insulin. Similar response was given by 80.0% for mean VPT and 100% for MPG.
Conclusion: This paper highlights the efficacy of improving health numeracy as a means of enhancing shared decision making, and facilitating insulin initiation in type 2 diabetes. It reveals the higher importance of mean plasma glucose values, rather than HbA1C and mean VPT in motivating patients to accept insulin.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.