Abstract

This pilot observational study examines the effect of the COVID-19 restrictions, transportation, and health
literacy (HL) during the pandemic on HbA1c testing rates at a local Federally Qualified Health Center (FQHC). We hypothesize that identifying the impact of these barriers will provide opportunities for action to improve the HbA1c testing rates among adult patients with diabetes at FQHCs. Inclusion criteria includes HbA1c ≥ 7% and non-compliance (no follow-up scheduled for ≥ 6 months). Exclusion criteria included Spanish speakers and age <18 Y/O. We performed a ten-question phone survey using the 5-point Likert scale at variable days and times of the week. The impact of the COVID-19 pandemic restrictions was gauged using the number of missed appointments and missed medication doses. The effects of transportation were measured by whether transportation led to missing appointments and the mode of transport used. HL was analyzed based on the numerical value assigned to a specific answer choice. A lower value correlated to Inadequate/Marginal HL.
We contacted 27 patients and 7 consented to survey completion. HL was the most significant concern, with 6 patients displaying Inadequate/Marginal HL. These same patients had low HbA1c testing rates (did not schedule an appointment within the last six months) and abnormal HbA1c levels (≥7%). HL is a major social determinant of health that impacts HbA1c testing rates. The restrictions during the COVID-19 pandemic perhaps contributed to this finding, but this study showed no correlation. Transportation did not hinder HbA1c testing rates, as all had a vehicle. For future interventions, patients who suffer from poor HL may benefit from
educational material like HbA1c brochures and increased follow-up from the FQHC.