Background

Type 2 diabetes mellitus (T2DM) remains a significant public health concern, disproportionately affecting uninsured and underserved populations who often face barriers to accessing education, resources, and consistent healthcare (American Diabetes Association, 2024). Limited health literacy and gaps in diabetes self-management knowledge contribute to poor glycemic control and increased risk of complications. Targeted educational interventions such as structured diabetes self-management education programs, individualized counseling sessions, and multidisciplinary education models have demonstrated improved patient understanding and engagement in chronic disease management and glycemic outcomes. However, many of these interventions require trained clinicians, multiple sessions, and ongoing follow-up, which may limit feasibility in low-resource clinical settings (Chrvala et al., 2016). There remains a need for practical, low-cost educational disease management strategies that can be implemented in resource-limited clinical environments.

This pilot study evaluated the effectiveness of a brief, clinic-based educational intervention on patient knowledge and self-efficacy related to T2DM management at Julia’s Center for Healthcare, a non-profit clinic in North Texas serving uninsured individuals.

Methods

A pre–post study design was utilized. Adult patients diagnosed with T2DM were recruited during routine clinic visits and participated in a structured educational session using a standardized, low-literacy diabetes education pamphlet designed to provide clear, culturally appropriate information on disease management (Powers et al., 2020). Exclusion criteria were patients with cognitive impairment or inability to complete the survey in English or Spanish.

The intervention focused on key topics including diabetes pathophysiology, potential complications, nutrition, lifestyle modifications, and social determinants of health. The intervention differed from usual care by providing a brief, structured, individualized, and interactive education session delivered in real time by trained second year clinical PA students investigators, rather than the standard brief or passive educational materials typically provided during clinic visits.

Participants completed pre- and post-intervention surveys designed to assess diabetes-related knowledge and perceived self-efficacy in managing their condition. The survey instrument included multiple-choice and Likert-scale questions developed for this study to capture changes in understanding and confidence. Statistical analysis was performed using a non-parametric Wilcoxon signed-rank test to evaluate pre- and post-intervention differences in knowledge and self-efficacy scores, given the small sample size and non-normal distribution of the data.

Results

A total of 21 patients completed both the pre- and post-surveys. The majority identified as Hispanic/Latino, reflecting the clinic population. Other demographic characteristics were not collected. Results demonstrated a statistically significant improvement in knowledge scores related to diabetes pathophysiology, nutrition, and recognition of complications following the intervention (pre-survey mean = 25.6; post-survey mean = 29.1; p = 0.0043). Confidence in dietary management improved (p = 0.02), and confidence in recognizing complications also improved (p = 0.03). These findings indicate that the intervention was associated with improvements in both knowledge and confidence in key areas of T2DM self-management.

Conclusion

The results of this study suggest that brief, structured, low-cost, accessible educational interventions that are incorporated into routine care can improve both patient knowledge and confidence in managing chronic conditions within underserved populations. While this study was limited by a small sample size, a short follow-up period, and reliance on self-reported measures, it provides a foundation for future research, including the impact of similar interventions on clinical outcomes such as A1c, long-term health behavior change, and scalability across diverse healthcare settings (Walker et al., 2014). Additional low-cost strategies that may be implemented in resource-limited clinics include group-based education sessions, culturally tailored printed materials, brief one-on-one counseling during routine visits, use of community health workers or student-led education initiatives, and incorporation of mobile health or text-based reminders to reinforce key concepts.

Acknowledgement

The authors would like to thank Dr. Jane Price for her mentorship of the PA students at Julia’s Center.