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Nurses are fairly regarded as the key players in a process of disseminating knowledge among patients. McGonigle and Mastrian (2012) confirm that "knowledge dissemination in nursing practice includes sharing information with patients and families so that they understand their healthcare needs well enough to participate in developing the plan of care" (p. 361). In other words, the knowledge provided by nurses must be comprehensive enough to enable patients to create and implement relevant health strategies, regardless of their health literacy levels. Some methods of patient education and their effectiveness will vary, depending on the circumstances of the case such as one-on-one hospital instructions, training sessions involving children and their parents, or group discussions (McGonigle & Mastrian, 2012). Still, the paper-based education remains one of the most promising models used by nurses to improve the patients' health literacy. Against the richness of credible and non-credible information provided through the Internet, paper-based education has the potential to enhance the quality of health strategies used by patients. The convenience of paper-based education should not be ignored. Printed materials can be easily distributed among patients, who will review them whenever they feel like learning (McGonigle & Mastrian, 2012). It is why printed handouts with essential health information do not lose their popularity among other forms of the patient education.

Introduction: Explaining the Issue and Choosing the Audience

Explaining the Issue: Pediatric Diabetes

Diabetes remains one of the most prevalent conditions among children. Saravanan and Mohanty (2012) define it as a serious metabolic condition associated with chronic hyperglycemia. It develops as a result of abnormalities in insulin secretion and actions. Diabetes causes negative impacts on the patterns of metabolism in the human organism, including the metabolism of fat and carbohydrates (Saravanan & Mohanty, 2012). Most children with diabetes suffer from the Type 1 of the disease. 97 percent of children with diabetes are diagnosed with the Type 1 (Saravanan & Mohanty, 2012). Meanwhile, the incidence and prevalence of the Type 2 Diabetes in children continues to increase. Saravanan and Mohantry (2012) mention the growing number of children with insulin autoantibodies. Because diabetes cannot be cured, kids need to know how to reduce the risks of health complications. They must also understand the nature of the disease, the patterns of its progression, and the ways, in which they can effectively manage their health state without being admitted to hospitals.

Choosing the Audience: Children

In this project, children are a target audience. The choice of kids as the target audience for this handout is justified by several important factors. First, children do not display high levels of health literacy. However, it is widely recognized as a vital component of high-quality medical care (DeWalt & Hink, 2009). Unfortunately, most patients in the developed world lack the level of literacy needed to understand even the basic health information (Baum & Dowling, 2011; Huff, 2011). Nurses have an easy access to a variety of health literacy resources. However, these resources cannot be effective, unless they are used to raise a level of health literacy in diverse groups of patients (Harvard School of Public Health, 2010; Office of Disease Prevention and Health Promotion, n.d.; U.S. Department of Health and Human Services, n.d.).

Second, children are likely to be the primary victims of low health literacy, particularly in the case of diabetes and the risks of complications. The fact is that the level of health literacy is directly associated with the outcomes of diabetes care and self-care (Schillinger et al., 2002). The role of parental literacy also should not be disregarded: even the basic numeracy skills greatly contribute to the effectiveness of glycemic control in children with diabetes (Pulgaron et al., 2014). Unfortunately, like any other vulnerable population group, kids keep suffering from the lack of medical attention. Even though the public health agenda is designed to address the existing health literacy disparities in diabetes self-care, children are still subject to greater risks of health complications due to diabetes (Gonzalez, 2012). Simultaneously, health literacy in kids with diabetes cannot be improved, unless parents are actively involved in a process of patient education. The handout below is designed to educate children with diabetes and their parents as well as provide them with the most important information to support their self-care attempts.

Handout: Diabetes - Quick Guide for Children and their Parents

Dear Child,

You have spent quite a lot of time at this hospital to understand that something is wrong with your health. You feel unwell. You feel confused. You are very emotional about your diagnosis. Possibly, you cannot believe that this is happening to you. However, you should know that your disease will not prevent you from living a normal life. You can still be a good student and a good friend to your peers. You have wonderful parents, who will be with you, whenever you need them. What you need is following a set of simple recommendations, which will make your life easier and better. However, before we switch to recommendations, let me explain what your diagnosis means to you.

First of all, diabetes means that your blood sugar is too high. You constantly get some amount of glucose, or blood sugar, from the food you eat. You need glucose to keep your brain and body active. However, it is not healthy to have too much glucose in your blood. It is why you can feel thirst, weaknesses, dizziness, and other symptoms.

Second, you should know that diabetes can be of two different types. Remember that the amount of glucose in your blood can be regulated with the help of insulin (IN-suh-lin). Insulin is generated in the pancreas, one of your body organs. In the Type 1 diabetes, the pancreas cannot generate any insulin, because its cells are destroyed. In the Type 2 diabetes, the pancreas generates enough insulin, but its cells do not work well enough to make a good use of it. Do not worry, because you have everything to control your disease and make your life better. You can live a life of a healthy child, meet your friends, play games, and enjoy various social activities, if you follow simple recommendations.

  1. Be physically active. It is always enjoyable to go to a gym or spend some time swimming in a pool with other children. Of course, if you do not really like physical exercises, you can make some active movements while watching TV, listening to music, or walking to school, or the nearest mall with your parents. Use any free moment you have to make some light physical activities to keep your body fit!
  2. Keep your weight within healthy limits. It is one of the most important things in your life, if you have diabetes. You can become more physically active or review the foods you eat every day. It is always possible to eat healthy and delicious food products. Ask your parents to create a unique and colorful food plan for you!
  3. Choose healthy foods. Healthy foods will help you to keep your blood glucose in balance. Make sure you eat vegetables, yogurts, cereals, meat, and poultry but avoid soda, cookies, candy, desserts, and too much fat.

When you are physically active and eat healthy foods, you will have all chances to live a happy life even with diabetes!

If you still want to know more about diabetes or the best ways to keep yourself fit and healthy, you can use the following resources online.

  1. What do kids need to know about diabetes?     ow_eng.pdf.
  2. Guide to the Type 1 diabetes for children (interactive):
  3. Moseka and her friends – a happy tale of how to live a good life with diabetes.   
  4. Diabetes & Kids brochure.
  5. What happens in diabetes? A movie for kids.


  1. Baum, N. H. & Dowling, R. A. (2011). Health literacy: How do your patients rate? Urology Times, 39(9), 32.
  2. DeWalt, D. A., & Hink, A. (2009). Health literacy and child health outcomes: A systematic review of the literature. Pediatrics, 124 (Suppl 3), S265-S274. DOI: 10.1542/peds.2009-11628.
  3. Harvard School of Public Health. (2010). Health literacy studies. Harvard School of Public Health. Retrieved from
  4. Huff, C. (2011). Does your patient really understand? Hospitals & Health Networks, 85(10),     34-38.
  5. McGonigle, D., & Mastrian, K. (2012). Nursing informatics and the foundation of knowledge. Burlington, MA: Jones & Bartlett Publishers.
  6. Office of Disease Prevention and Health Promotion. (n. d.). Health literacy online. HHS. Retrieved from
  7. Pulgaron, E. R., Sanders, L. M., Patino-Fernandez, A. M., Wile, D., Sanchez, J., … Delamater, A. M. (2014). Glycemic control in young children with diabetes: The role of parental health literacy. Patient Education and Counseling, 94, 67-70. DOI: 10.1016/j.pec.2013.09.002.
  8. Gonzalez, A. (2012). Vulnerable populations and diabetes. Diabetes Spectrum, 25(1), 6-7.
  9. Saravanan, S. L., & Mohanty, R. (2012). Diabetes in children. InnovAiT, 5(2), 83-93. DOI:             10.1093/innovait/inr172.
  10. Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., … Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. Journal of American Medical Association, 288, 475-482.
  11. U.S. Department of Health and Human Services. (n.d.). Quick guide to health literacy. HHS. Retrieved from

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