The study was conducted for the purpose of designing and evaluating an educational program for undereducated diabetes mellitus patients. The program as designed integrated recommended emphases found in the literature for the development of educational programs for low literacy levels and accounted for cultural relevancy.

Developed program components were the diabetic diet guide and an audiotape-slide presentation entitled, "How to Follow the Diabetic Diet Guide." Concentrated efforts were made to develop understandable and applicable dietary education materials. Educator and professional dietitian expertise were utilized in the formation and completion of the program design. Patients similar to potential study participants voluntarily served as trial learners provided input relative to realistic content transmission, application to the daily dietary regimen, and comprehensibility.

The program components are clear, concise, colorful, visually-oriented, and interesting. The provision of an easy-to-follow guide for regular home use allows for repetitive application of required dietary principles.

The content emphasis was on the necessary concepts for dietary control of the disease. Knowledge areas included nutritional knowledge basic to the disease, the foods in food groups, the measurement of serving sizes of foods using standard methods, unrestricted foods, restricted foods, the use of fat in food preparation, and the advocacy of an established eating routine throughout the day from day-to-day. In the diabetic diet guide, the aforementioned concepts were clearly and colorfully presented so that literacy was not required. The same concepts utilizing portions of the guide were reinforced by a unisex cartoon character explaining use of the guide.

Evaluation instruments were designed to test program effectiveness with an undereducated diabetes mellitus patient population. The instruments (developed by the researcher) were a 70-item knowledge test, a 24-hour recall record, and a medical chart information sheet.

A field test trial was conducted with 50 participants who are served on an outpatient basis. The site was the High Point Memorial Hospital Outpatient Clinic, funded by the health department. Fifty consenting participants were randomly assigned to experimental and control groups by a ratio of two to one by race and sex. Thirty-two experimental and 18 control subjects completed the study. All data collection was orally solicited initially, at two months, and at four months. The educational intervention was presented only to experimental subjects.

Evaluation of increments in knowledge, decreases in weight, blood glucose values, and minimal acute complications indicated the newly designed program was successful. The data was subjected to statistical analysis using analysis of covariance. The initial scores or readings were used as covariates to control for initial variances.

Knowledge scores improved significantly from the beginning to the end of the study (p ≤ 0.0001). Knowledge attainment must occur for subsequent application as reflected by clinical measurements.

The desirable clinical measurements were generated during the four-month study as shown by statistically significant decreases in blood glucose values (p < 0.05) and a pronounced trend in weight loss. A further indication of success was that the experimental population had fewer acute complications than the control subjects.