The Spoken Knowledge in Low Literacy in Diabetes Scale

Abstract

Purpose The purpose of this study was to develop and validate a new knowledge scale for patients with type 2 diabetes and poor literacy: the Spoken Knowledge in Low Literacy patients with Diabetes (SKILLD). Methods The authors evaluated the 10-item SKILLD among 217 patients with type 2 diabetes and poor glycemic control at an academic general medicine clinic. Internal reliability was measured using the Kuder-Richardson coefficient. Performance on the SKILLD was compared to patient socioeconomic status, literacy level, duration of diabetes, and glycated hemoglobin (A1C). Results Respondents’ mean age was 55 years, and they had diabetes for an average of 8.4 years; 38% had less than a sixth-grade literacy level. The average score on the SKILLD was 49%. Less than one third of patients knew the signs of hypoglycemia or the normal fasting blood glucose range. The internal reliability of the SKILLD was good (0.72). Higher performance on the SKILLD was significantly correlated with higher income (r= 0.22), education level (r= 0.36), literacy status (r= 0.33), duration of diabetes (r= 0.30), and lower A1C (r= –0.16). When dichotomized, patients with low SKILLD scores (= 50%) had significantly higher A1C (11.2% vs 10.3%, P< .01). This difference remained significant when adjusted for covariates. Conclusion The SKILLD demonstrated good internal consistency and validity. It revealed significant knowledge deficits and was associated with glycemic control. The SKILLD represents a practical scale for patients with diabetes and low literacy.