The STEPP-UP Project—Designing Low Literacy Teaching Tools for Use of Devices in a Minority Population
Authors: RUELAS VALERIE F. , WALKER MARTHA A. , PETERS ANNE L. 
Published: June 2018

Health care disparities exist with regards to treatment of individuals with type 1 diabetes. One of many barriers is the lack of non-branded, simple, lower literacy teaching tools in English and Spanish. Current manuals are generally written at an 11th grade reading level. In our population, due to the expansion of coverage through the Affordable Care Act, more patients had access to pumps and pens, but lacked appropriate educational materials. Thus, our project was designed to develop and test lower literacy teaching tools, using focus groups, for both English and Spanish learners. Informational websites, educational guides and product manuals about insulin pumps and pens were assessed for readability, comprehension, linguistic and cultural appropriateness as well as overall likes and dislikes of how information was presented. Formative focus group analysis indicated that materials were not easily understood and did not address patient fears about insulin pen and pump technology. There was a desire for more pictures and to have information in a question/answer format. New materials were developed along with an illustrator and an expert in clear language adaptation for low-literacy English and Spanish speakers. The following guides were translated into Spanish and have accompanying educational trainers’ manuals: Is the Insulin Pump Right for Me?, How Do I Use an Insulin Pump?, How Do I Use an Insulin Pen? and How Can I Manage My Type 1 Diabetes Better? The most challenging aspect of the guide development was lowering the grade reading level due to the medical and technology terms. The use of over 100 illustrations along with the glossary of terms was reported to have significantly increased the readers understanding of the information presented. A readability consensus of 8 scales scored the material text at an “easy to read” reading level with a grade level of “5” and a reader’s age of “8-9 (grades 4 and 5).” These free of charge materials are available in a printable and online use format.

Disclosure
V.F. Ruelas: Research Support; Self; National Institutes of Health, MannKind Corporation, AstraZeneca, Leona B and Harry M Helmsley Charitable Trust. M.A. Walker: Research Support; Self; Leona M. and Harry G. Helmsley Charitable Trust. A.L. Peters: Advisory Panel; Self; Abbott, Bigfoot Biomedical. Research Support; Self; Dexcom, Inc.. Advisory Panel; Self; Eli Lilly and Company, Insulin Algorithms, JDRF, Lexicon Pharmaceuticals, Inc., Livongo Health. Research Support; Self; MannKind Corporation. Other Relationship; Self; Medscape. Advisory Panel; Self; Merck & Co., Inc.. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Omada Health, Inc., Optum Rx, Inc., Sanofi. Research Support; Self; T1D Exchange. Advisory Panel; Self; The Endocrine Society. Research Support; Self; The Leona M. and Harry B. Helmsley Charitable Trust. Advisory Panel; Spouse/Partner; Johnson & Johnson Diabetes Institute, LLC..