All participants, regardless of age, sex, or country of origin, expressed consistently positive responses, stating that the content was understandable and relevant. They recommended some culture-specific wording changes. It was also decided to revise the PDA from seventh/eight grade reading level to third/fourth grade level.

The researchers concluded that their initiative “supports the importance of developing culturally sensitive tools for Hispanic/Latinos with poorly controlled T2DM, as disparities exist.”11


The English version PDA “is evidence-based and the content is consistent with current recommendations and clinical guidelines.”5 While the Spanish version is still undergoing further study with a wider Hispanic/Latino audience, it has shown enough promise to already be available for clinician use. Both PDA versions are available at

Image courtesy of


  1. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press, 2001.
  2. US Department of Health and Human Services. Agency for Healthcare Research and Quality (AHRQ).  List of CAHPS Measures. Available at: Accessed: June 17, 2015.
  3. American Diabetes Association (ADA). Standards of Medical Care in Diabetes. Diabetes Care 2015;38(Suppl. 1):S1–S80.
  4. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE/ACE comprehensive diabetes management algorithm 2015. Endocr Pract. 2015;21(4):438-447.
  5. Shillington AC, Col N, Bailey RA, Jewell MA. Development of a patient decision aid for type 2 diabetes mellitus for patients not achieving glycemic control on metformin alone. Patient Prefer Adherence. 2015;9:609-617.
  6. Elwyn G, O’Connor A, Stacey D, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333(7565):417.
  7. Elwyn G, O’Connor AM, Bennett C, et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One. 2009;4(3):e4705.
  8. Joseph-Williams N, Newcombe R, Politi M, et al. Toward  minimum standards for certifying patient decision aids: a modified Delphi Consensus Process. Med Decis Making. 2013;34(6):699-710.
  9. Dominguez K, Penman-Aguilar A, Chang MH, et al. Vital signs: leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States – 2009-2013. MMWR Morb Mortal Wkly Rep. 2015;64(17):469-478.
  10. Camarota SA. Immigrants in the United States. 2010: A Profile of America’s Foreign-Born Population. Washington DC: USA: Center for Immigration Studies, 2012.
  11. Davidson JA, Rosales A, Shillington AC, et al. Improving access to shared decision-making for Hispanics/Latinos with inadequately controlled type 2 diabetes mellitus. Patient Prefer Adherence. 2015;9:619-625.