Informed Decision-Making about Statins in Low Literacy Primary Care Patients

J. Travis Gossey, M.D. Principal Investigator
Robert J. Volk, Ph.D., Senior Scientist

Specific Aims

  1. To develop a new statin decision aid for low-literacy patients in English and Spanish.

  2. To evaluate the potential efficacy of a statin decision aid for improving informed statin choice and compliance in low-literacy patients.


The preliminary stage (Specific Aim 1) of this study was completed during the first quarter of 2008. We interviewed 18 patients, 12 in English and six in Spanish. Participants discussed their experiences with the use of statins and also gave their opinion on a variety of cholesterol education materials.The interviews were coded and analyzed. The feedback was used to create an audio booklet which provides statin information in a format appropriate for low-literate populations. We have now begun the next phase, which is a pilot study to test the audio booklet for statin decision-making.  A total of 120 patients determined to be low-literate with high cholesterol were shown the audio booklet with information on statins, which consists of voice recordings of patient-physician encounters, as well as a written booklet.  Participants discussed their experiences with the use of the audio booklet decision-aid and rated its effectiveness as an educational tool. Analysis of this data is underway.

Improving Outcomes for Multiple Morbidities Using Collaborative Group Clinics to Empower Older Patients 

Aanand D. Naik, M.D., P.I.
Richard Street, Ph.D., Senior Scientist

Specific Aims

To develop and test a model of collaborative group clinics that empowers older patients to adopt goal-setting behaviors, increased communication with their health care provider and improves their diabetes-related outcomes.


The group clinic sessions for diabetes self-management at the Veteran’s Administration have ended for this study.Of the 129 total patients who participated in the group clinics, seven individuals were in the non-randomized pre-pilot, 64 were randomized to the intervention group and 58 were randomized to the control group. Participants in the intervention group attended a group clinic every three weeks for four sessions (12 weeks). Each visit focused on diabetes, hypertension and lipids control. Patients also participated in group-based education and feedback sessions, with an individualized process of selecting and modifying care goals for diabetes control. Participants in the control group received standard of care. Follow-up for all patients, which includes lab data and a post-test questionnaire, is now complete and data analysis is underway.

Understanding Patient Choices in Joint Replacement

Simon Whitney, M.D., P.I.
Maria E. Suarez-Almazor, M.D., Ph.D., Senior Scientist

Specific Aims

  1. To develop and pilot test conjoint analysis as a decision aid for patients who are candidates for knee joint replacement, and to ascertain the utilities of patients who are at low, intermediate and high risk of complications and premature prosthetic failure.

  2. To undertake a RCT of the decision aid to evaluate patient participation in the decision and extent of decisional conflict at the time of the visit, and satisfaction with decision three and six months after the visit.

  3. To use conjoint analysis to measure patient utilities for health states associated with conservative versus surgical treatments of their knee osteoarthritis.


An adaptive conjoint analysis (ACA) software program has been tailored to the needs of this specific project and pilot tested with 18 patients at Baylor College of Medicine Family Medicine clinics. Recruitment for the RCT to determine the efficacy of the ACA program is underway.

Applying Social Marketing Techniques to Improve Therapeutic Adherence in Patients with Human Immunodeficiency Virus 

Thomas Giordano, M.D., M.P.H., P.I.
Maria E. Suarez-Almazor, M.D., Ph.D., Senior Scientist

Specific Aims

  1. To develop a pilot intervention based on social marketing techniques that can be applied in a resource-constrained healthcare system dedicated to the treatment of persons with HIV infection.

  2. To demonstrate the feasibility of implementing the intervention in that clinic.

  3. To test the impact of the intervention on adherence to antiretroviral therapy.


Specific Aim 1 involved qualitative data collection to inform the development of the intervention. A total of 31 patients participated in focus groups. After detailed analysis of this qualitative data, a social marketing intervention has been developed. To pre-test this intervention 250 participants completed surveys. The social marketing intervention will be implemented in the HIV clinic for a three-month period. A post-test of 250 participants will be undertaken and completed by early 2010. Additionally, pharmacy refill data will be utilized to determine the efficacy of the intervention. 

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