Date of Award


Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Hristova, Lena

Faculty Reader

Pusztai, Julie

Executive Summary

Executive Summary

Developing Diabetes Management Health Education Module for Adults Learners Teaching Homeless Adults

Background and Significance: About 77 million American adults are unable to manage their chronic conditions due to a lack of knowledge and skill1. Low health literacy among the homeless adult population leads to poor health outcomes and extensive spending on healthcare2, 3, 4. Personnel at the shelter for homeless veterans are often the only caretakers who can provide diabetes self-care and harm reduction guidance for their clients.

Problem Statement: Staff at the shelter for homeless veterans lacks knowledge about diabetes pathophysiology, acute and chronic complications, emergency management, and harm reduction strategies. Due to a lack of knowledge, shelter staff doesn`t feel confident in providing diabetes care teaching and guidance to their homeless clients.

Purpose: Develop a health literacy education curriculum for the shelter staff. Shelter staff will provide diabetes education for homeless adults with the intention of improving their healthcare outcomes.

Methods: Diabetes health education module was developed according to current evidence-based practices and presented to shelter staff via the remote learning modality using ZOOM platform. To assess teaching effectiveness and information retention, a pre-test/post-test design was used. All shelter personnel and volunteers were invited to participate.

Results: One pre-test and 3 post test scores were compared to determine participant knowledge improvement after attending the diabetic education session. Staff knowledge retention and confidence were measured. The survey indicated a satisfactory knowledge retention (measured as test scores, in percents) over a four week period and exceeded the aimed 75%. Information about staff confidence levels on providing homeless shelter clients diabetes education was collected via Survey Monkey software. Compared to the pre-session, staff confidence levels improved from 34% to 100%. It was noted that participant’s confidence levels slightly declined to 67% at 4 week mark, so more frequent training needed to stabilize confidence of staff.

Sustainability: To ensure sustainability of the project shelter administration appointed an assisted manager who will lead the education program based on project curriculum. Regular education sessions will be scheduled for staff and shelter clients across sister shelters within non-profit.

Implications for Practice: Uncontrolled diabetes can lead to permanent disability and death. Advancing shelter staff knowledge about diabetes and its adversities can improve staff knowledge about diabetes and will positively impact the homeless client’s outcomes. The education curriculum was built in an easy to understand manner, and was applicable to the homeless population. Moreover, it can be disseminated to other non-profit organizations and used as a foundation for training in any place where it can be pertinent.


  1. America's health literacy: Why we need accessible health information. (2008). Retrieved April 22, 2019, from U.S. Department of Health and Human Services website:

  1. Axon, R. N., Gebregziabher, M., Dismuke, C. E., Hunt, K. J., Yeager, D., Santa Ana, E. J., & Egede, L. E. (2016). Differential impact of homelessness on glycemic control in veterans with type 2 diabetes mellitus. Journal of General Internal Medicine, 31(11), 1331-1337.
  2. Poureslami, I., Nimmon, L., Rootman, I., & Fitzgerald, M. J. (2017). Health literacy and chronic disease management: Drawing from expert knowledge to set an agenda. Health Promotion International, 32(4), 743-754.
  3. What we know about users with limited literacy skills. (2016, June 8). Office of Disease Prevention and Health Promotion. Retrieved August 4, 2020, from