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DOI: 10.1177/0145721705275002 © 2005 American Association of Diabetes Educators; Published by SAGE Publications
The Spoken Knowledge in Low Literacy in Diabetes ScaleA Diabetes Knowledge Scale for Vulnerable PatientsFrom the Center for Health Services Research, Vanderbilt University Medical Center, and the Diabetes Research and Training Center (DRTC), Vanderbilt University, Nashville, Tennessee (Dr Rothman); the Department of Medicine, University of North Carolina, Chapel Hill (Drs Malone, Bryant, Padgett, DeWalt, Pignone); Clinical Pharmacy Services, Grady Memorial Hospital, Atlanta, Georgia (Dr Wolfe); and the Department of Health Policy and Administration, University of North Carolina, Chapel Hill, and the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina (Dr Weinberger). Correspondence to Russell L. Rothman, MD, MPP, Center for Health Services Research, Vanderbilt University Medical Center, Suite 6000 Medical Center East, Nashville, TN 37232-8300 (russell.rothman{at}vanderbilt.edu). 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 ( Conclusion The SKILLD demonstrated good internal consistency and validity. It revealed significant knowledge deficitsand was associated with glycemic control. The SKILLD represents a practical scale for patients with diabetes and low literacy.
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50%) had significantly
higher A1C (11.2% vs 10.3%, P < .01). This difference remained
significant when adjusted for covariates. 
