In 2015, the Institute of Medicine (IOM) estimated that around 50% of Americans have difficulty understanding and making healthcare choices whereas in Europe, insufficient or ‘problematic’ health literacy levels ranged from 29% (Netherlands) to 62% (Bulgaria). Of particular concern is that low health literacy is a stronger predictor of poor disease prognosis than all the other demographic factors (including income). Patients facing the threat of well-known chronic diseases like diabetes mellitus (DM) may encounter difficulties in a range of skills, from reading information written on drug packages to scheduling drug doses, reading and interpreting blood sugar values, comprehending informed consents, informational brochures and other materials. This is why poor health literacy skills cast serious threats to adherence to treatment plans. They also make disputable the consent process, as the level of real understanding of medical terms that patients consent with routinely is overestimated.
The low percentages of adequate health literacy among general population together with the increasing prevalence of diabetes mellitus (11.6% of the people in Romania, above the European average prevalence) are strong arguments for the need to develop coherent education interventions to increase nutrition literacy. Thus, the overarching aim of the project is to test the effectiveness of a mobile nutrition literacy application on subsequent nutritional proficiency and on short-term self-management of disease in patients with diabetes.
In order to reach project’s aims, I will employ a mix of qualitative and quantitative methods for: 1) selecting the strategies for delivery and establishing the contents of the nutritional literacy app and 2) testing the nutritional literacy app against usual information delivery in a controlled trial using two randomly selected samples of patients with DM. The tasks subsumed to project aims will unfold on three workstreams (WS) spread over a 24-month period.
WS1. Establish the areas, the contents of intervention and the measurements of nutrition literacy in patients with diabetes (Month 1-Month 9)
WS2. Translation of intervention contents into the mobile app (Month 6-Month 14)
WS3. Controlled trial to test mobile app nutrition literacy intervention against standard information in patients with DM (Month 15-Month 23)