Knowledge improvement with web-based diabetes education program: Brainfood

Background: Health literacy has a direct effect on health outcomes, but the complexity of diabetes education and time constraints on the health care team have made delivery of this education difficult. Methods: The Florida Initiative in Telemedicine and Education developed an education website (Brainfood) for multiple literacy levels. The site consists of 19 education units, 15 of which provided gradable test scores; a narrated cartoon provides essential information to low reading level learners. Text is presented at both 4th and 101 grade level. Literacy level of the user is not evaluated; rather, users choose their preferred format. The administrative backbone stores user demographics and test scores. Nurses can receive credit hours for completion of Brainfood, 13 tests required. Results were analyzed by a non-paired t test. Results: Five hundred thirteen users have logged in to the site and clicked "I agree" on an informed consent. Of non-nurses, 145 of 389 took pre-tests (range 89-145 depending on module), and 135 took post-tests (range 84-135). For each of the 15 modules, post-test scores improved significantly (P < 0.001 by non-paired t test). Of nurses, 68 of the 124 took pre-tests (range 26-68), and up to 56 (range 24-56) took post-tests. Post-test scores improved significantly (P < 0.05 by non-paired t test) on 13 modules. Post-test scores improved, but were not statistically significant for "Nutrition 101," a module about very basic nutrition. Web-based education about Type 1 diabetes mellitus improved the knowledge level of all users. Nurses had a lower margin of improvement for most modules as they started with a higher base knowledge level. Non-nurses improved significantly on all modules from pre-test to post-test. Post-test scores for the nurses and non-nurses were indistinguishable. Conclusion: Brainfood, a web-based diabetes education program, is educationally sound and effective at delivering Type 1 diabetes mellitus education to both professionals and non-professionals. Web access from non-clinic settings can improve access to high-quality education for learners in remote or underserved locations.