Indiana University School of Medicine
Indianapolis
Diabetes and Cardiovascular Disease Risk Factors
Spanish-speaking Latinos

Project

Patients received an individualized multimedia presentation on cardiovascular disease risk factors.

Patients with type 2 diabetes view an individually tailored multimedia presentation designed for a low-literacy, Spanish-speaking audience. The presentation informs patients about their own cardiovascular disease risk and facilitates dialogue between patients and providers regarding possible strategies to reduce cardiovascular disease risk. Patients view the initial presentation, consisting of six segments and lasting approximately 12-13 minutes, on a tablet computer, in the waiting room prior to their office visit. The initial presentation includes information about the patient’s 10-year risk of death or heart attack. It also presents their most recent HbA1c, blood pressure, cholesterol and smoking status information, compared to targets.

Additional segments of the initial presentation include illustrations and descriptions of a heart attack, a testimonial from a recovering heart attack patient, a review of options for reducing risk, and a brief coaching session. Presentations at subsequent visits address specific cardiovascular disease risk factors.

Rationale

Though cardiovascular disease is the leading cause of death in Latino patients with type 2 diabetes, risk factors for the disease are under-treated. This intervention provides an efficient means of communicating individualized health risk information to patients in an environment where health care providers often lack the time to properly inform patients themselves, or have difficulty communicating across a language barrier.

Additionally, the tablet multimedia presentation uses graphics and testimonials to make the health information messages more accessible to patients with low health literacy, and has been tailored to reflect Spanish-speaking Latino cultural beliefs and norms. More effectively communicating these risk factors, and the behaviors necessary to address them has the potential to improve medication adherence, clinical outcomes, patient and physician satisfaction, and health-related quality of life.

Summary Results

Individualized multimedia presentations on cardiovascular disease risk factors (hypertension, hyperlipidemia, diabetes, and heart attack) shown to diabetic Hispanic patients in clinic increased the frequency and ease of discussion about cardiovascular risk factors between patients and their providers. Patients spoke to their providers statistically sooner regarding their risk of heart attack (hazard ratio: 1.82; 90% vs 50% controls by first visit) and high blood pressure (hazard ratio: 1.95) but not high cholesterol. This intervention also significantly improved the number of risk discussions per year for cholesterol (3.9 vs 2.1 controls), heart attack (3.8 vs 2.0 controls), and hypertension (3.7 vs 1.4 controls) but not for diabetes. Ultimately, the intervention did not result in any changes in medication or dosage for any of the risk factors, and there were no significant improvements in patients’ HbA1c, systolic blood pressure or LDL cholesterol levels.

Publications

Principal Investigators

• Paris Roach, MD
• David G. Marrero, PhD