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Diabetes Educ. 2005 Mar-Apr;31(2):215-24.

The Spoken Knowledge in Low Literacy in Diabetes scale: a diabetes knowledge scale for vulnerable patients.

Author information

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)
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)



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).


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).


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 (< or = 50%) had significantly higher A1C (11.2% vs 10.3%, P < .01). This difference remained significant when adjusted for covariates.


The SKILLD demonstrated good internal consistency and validity. It revealed significant knowledge deficits and was associated with glycemic control. The SKILLD represents a practical scale for patients with diabetes and low literacy.

[Indexed for MEDLINE]

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