Background and aims: Type 1 diabetes mellitus (T1DM) requires daily self-management to mimic endocrine function, using numerical skills such as carbohydrate counting and interpreting nutritional information. Healthcare professionals (HCPs) rely on effective communication to relay information to people with T1DM to enable good self-care. Curricula for diabetes self-management education (DSME) courses require high-school level numerical skills. Eighty percent of adults in the United Kingdom are functionally innumerate therefore an access gap exists: those with low numeracy may be unable to access DSME course content and optimise self-management. There has been no research studying HCP communication with patients with T1DM and low numeracy. Our study aimed to assess HCP perception of their patients numeracy and the effect this has on their communication approaches.
Materials and methods: This pilot, double-blinded, cross-sectional observational study recruited adults with T1DM attending specialist outpatient clinics in South London to complete a validated Diabetes Numeracy Test (DNT-5). Consultations were observed, using two checklists to measure HCP use of verbal and non-verbal communication techniques and information relayed by the HCP. Following consultation, HCPs (doctors or diabetes specialist nurses) estimated patients DNT-5 score. Analysis included descriptive statistics and Pearson correlation.
Results: Fifty-eight patients completed the DNT-5 test. 5 patients (9%) had low numeracy (scoring <3/5) and 53 patients (91%) had adequate numeracy (scoring ≥3/5). Mean±SD DNT-5 score achieved by patients was 4.17±1.02. The average HCP-perceived score was 3.72±1.20, with a significant relationship between the two (r=0.339, 95% CI 0.088 to 0.549, P < 0.05). The relationship between HCP perceived level of numeracy and filtering of diabetes information (χ2=9.04, P=0.94) and communication methods used by HCPs (χ2=14.50, P=0.88) did not reach significance. The commonest information conveyed was insulin dose adjustment for carbohydrate intake (48/58 [83%]) and explaining/changing dose of medication (46/58 [79%]).
Conclusion: Diabetes specialist HCPs are able to identify patients with low numeracy. They did not filter diabetes information ensuring equity of information provided. However, they did not tailor their communication methods to ensure that those with low numeracy understood the given information. This exploratory study provides a methodology for assessing the support available to people with low numeracy. We propose that HCPs require additional communication training so patients with low numeracy are able to understand all information provided. Further studies are required to confirm a resultant difference in patient recall following consultation.
18 - 21 May 2019
European Society of Endocrinology