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Capstone Committee Chair: Rickie Brawer, PhD, MPH, Jefferson Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.


As many as nine out of ten adults lack the skills needed to manage their health and the health of others. In the setting of a pediatric diabetes clinic, a child’s health outcomes are often determined by their caregivers’ literacy level. The purpose of this study is to assess the health literacy (HL) environment in a pediatric diabetes clinic. The study was conducted in the Endocrinology Department in an academic pediatric hospital. 70 staff members were asked to complete a survey on their use of predefined low HL techniques. A walk through assessment was performed to evaluate ease of navigating the clinic. Readability and suitability testing occurred by analyzing 5 randomly selected patient education materials, out of 137 patient education documents. I. Provider Survey: All but three providers (92.3 %) reported using simple language when working with patients and all but six providers used printed educational materials (84.6%). Teach-back (38.5%), follow up phone calls to the patient (30.8%), and using models to explain or educate (25.6%) were not being used routinely by more than half of the total respondents. II. Readability/Suitability of Materials. The FRY scores ranged from 5th to 9th grade and by the Flesch-Kincaid scores ranged from 4th to 7th grade. Three out of five education documents scored superior according to the Suitability Assessment of Materials. III. Navigation. The Center scored higher in helpfulness, employees being present, and staff wearing identification. Hallways were equipped with consistent signage, however, maps were still lacking and all signs were only written in English. The telephone tree proved to need improvement. Recommendations: enhance education for providers and staff on health literacy techniques, consider Fry Readability testing rather than using the Flesch-Kincaid score when assessing grade level, increase signage, especially in languages other than English, increase access to handheld maps, and improve the telephone tree.

Presentation: 24 minutes