The materials resonated with patients because they incorporated traditional Navajo beliefs, values and foods. Education regarding dietary changes is critical, so it is particularly important that clinicians reference traditional foods eaten by specific ethnic groups.

Also, audiovisual materials should include individuals, places, language, music, food, brands, locations and clothing that are familiar to the intended audience, the American Association of Diabetes Educators advises.

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Combating cultural myths

Clinicians working with vulnerable populations should also be prepared to combat culturally based myths and misconceptions about diabetes. In the book “Using Our Wit and Wisdom to Live Well with Diabetes,” author Barbara Mora, describes the influence of cultural beliefs on patient behaviour.

Mora described the beliefs of her Native American mother, who thought that diabetes was caused when all the bitter feelings inside a person made the blood go bad. Mora’s mother was later diagnosed with diabetes and died from complications — she saw the condition as punishment from a divine being, and not a health condition that could be managed.

Years later, when Mora herself was diagnosed with diabetes she had to overcome many of the cultural misconceptions and beliefs that she had about the disease before she could learn to live with her condition. The book, which is used as a diabetes education tool, focuses on Mora’s journey through the depression she experienced in the wake of her diagnosis, the reactions of those around her, and finally her ability to accept and take control of her condition.

While the misconceptions Mora held were unique to her background, clinicians should remain cognizant that other cultures may have similar beliefs that can present barriers to understanding and treatment if left unaddressed.

Serving low-literacy populations

Even the best educational information won’t be effective if patients do not have the capacity to understand it.

As many as one-in-three Americans have low health literacy, according to a study published in Clinical Diabetes5. And this is more than just difficulty reading health information; low health literacy can also mean that a patient has trouble understanding information that a physician provides. This can limit a patient’s ability to do numerous tasks from filling out medical forms to understanding how to take prescribed medications. Another concern for patients with low health literacy is that they may not be able to find the correct practitioners to treat their medical conditions.

Additionally, individuals with poor health literacy are more likely to have physical and mental health problems and a shorter life expectancy, the researchers wrote. They suggested the following tips:

  • Keep text simple, and make sure it is presented at a basic reading level.
  • Avoid medical jargon, and make sure the information is well organized to help the patient comprehend it more readily.
  • Avoid complicated phrasing when explaining diseases or treatment instructions to patients.
  • Use everyday terms to help patients absorb the information.
  • If a medical term is used, clinicians should be certain to provide the patient with an explanation of that term.
  • Whenever possible, avoid phrases that have more than one interpretation. For example, study authors said that a phrase such as “Insulin may prevent your diabetes from getting worse,” might be misinterpreted. To some patients, it will mean that there is no conclusive proof that insulin will have the desired effect. A patient with low health literacy might hear “Insulin will prevent your diabetes from getting worse.” Even subtle misinterpretations can have a big impact.
  • Put acronyms and other new terms in writing.
  • Explain common terms used in a typical ways. For example, a patient might assume a “negative” test result is bad and a “positive” test result is good.
  • Recognize that different cultures view different words differently, and be sensitive to this when explaining medical information to patients.
  • Ask open-ended questions to make sure the patient understands the information he or she has been given. Asking a patient to repeat the information back can help practitioners gauge how much he or she understood.
  • Refer patients to other organizations for additional assistance, if necessary.

Because controlling diabetes requires patients to have a good command of numbers, it’s also important to identify patients who have low numeracy skills, and provide them with additional tools and assistance. Vanderbilt University Medical Center provides patient numeracy assessment tools online, and the American College of Physicians Foundation has a Living with Diabetes guide.

Extending outreach efforts

Outreach programs in community settings are effective ways to reach individuals with diabetes who might not otherwise seek medical attention.

It is important to make it convenient for vulnerable groups to get screenings and education. In Arizona, members of the CDC’s Prevention Research Center collaborated with local health care organizations to provide one-stop screening for patients. Women were given a comprehensive preventative health screening during each visit, and lay health workers took time to teach women about diabetes control during the same visit.

Focusing on a variety of strategies can help educate patients and give them the tools they need to take control of their diabetes and their health.

Kelly Bilodeau is a freelance medical writer.


1. American Diabetes Association website.

2. US Department of Health and Human Services. National Diabetes Education Program website.

3.CDC. Prevention Research Centers website.

4. Huang ES. Diabetes Care. 2009;32:311-316.

5. Osborne CY. Clin Diabetes. 2010;28:171-175.