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Systematic review and evaluation of freely available online diabetes medication decision aids

Michael Fajardo, Laura Harris, Nikhil Naidoo, Lyndal Trevena, Carissa Bonner


Rationale, aims and objectives: Diabetes mellitus is likely to be in the top 10 leading global burden of diseases by 2030, where self-management of diabetes is one avenue to alleviate burden. Shared decision-making processes and the use of decision aids may help facilitate self-management in patients with diabetes. We aimed to identify and assess all publicly available online diabetes medication decision aids, for suitability for low health literate patients, in terms of their understandability and actionability.

Methods: Systematic review of public websites in August-November 2017 using an environmental scan methodology, assessment of clinical validity using a high-risk patient profile, assessment of understandability and actionability using the PEMAT-P subscales, readability using the Gunning Fog Index and Flesch­-Kincaid Reading score and ratings against the International Patient Decision Aids Standards Instrument Short Form (IPDASi-SF) and Version 4.

Results: Seven diabetes medication decision aids were identified in this study. The mean understandability score was 88% (SD = 10%) the mean actionability score was 52% (SD = 24%) which ranged from 17 to 80%. The mean Gunning Fog index was 10.8 (SD = 0.7), the mean Flesch­-Kincaid Reading Score was 10.1 (SD = 0.7) the mean IPDASi-SF score was 57.34 (SD=9.86). The Development subscale scores for the IPDASi-SF were poor (mean 1).

Conclusions: Understandability of the decision aids overall was good however with the US 10th grade reading levels they may not be suitable for a low health literacy audience. Actionability was also less than favourable.


Diabetes, decision aid evaluation, decision aids, economic burden, evaluation, health literacy, international decision aid criteria, patient-centered care, patient communication, patient education, person-centered healthcare, shared decision-making

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