Study guide
Assessing Learning: Goals, Readiness to Change & Literacy
CDCES Certified Diabetes Care and Education Specialist
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1 Introduction & the CDCES Exam
About the CDCES Credential & Current Exam Facts The July 2024 Exam Content Outline & Domain Weights The ADCES7 Self-Care Behaviors Framework
2 Pathophysiology, Classification & Diagnosis
Normal Glucose Regulation and the Pathophysiology of T1DM and T2DM Classification and Diagnostic Criteria Risk Factors and Primary Prevention Treatment Goals and Glycemic Targets
3 Assessment: History, Physical & Data
Health History & Diabetes-Specific Physical Assessment Interpreting Diabetes Measures & Laboratory Data Social Determinants of Health & Psychosocial Wellbeing
4 Assessing Self-Management & Learning
Assessing Self-Management Behaviors & Knowledge Assessing Technology Use, Problem-Solving & Risk-Reduction Behaviors Assessing Learning: Goals, Readiness to Change & Literacy Learning Considerations & Barriers
5 Developing the Education & Care Plan
Developing the Individualized Education/Care Plan Instructional Methods & Person-Centered Teaching Strategies SMART Goals, Behavior-Change Theory & Motivational Interviewing
6 Nutrition Therapy
Nutrition Recommendations & Eating Patterns Carbohydrate Counting & Insulin-Food Timing Fats, Protein, Alcohol & Dietary Supplements Food Labels, Weight Management & Special Nutrition Considerations
7 Physical Activity
Physical Activity Recommendations, Benefits, Challenges & Safety Activity Planning with FITT and Adjusting for Planned & Unplanned Activity
8 Pharmacologic Therapy
Insulin — Types, Pharmacokinetics & Delivery Systems Non-Insulin Glucose-Lowering Agents Guideline-Based Medication Selection Medication Titration & Immunizations for People with Diabetes
9 Monitoring
Glucose Monitoring: SMBG, CGM & Time in Range A1C and Ketone Monitoring Cardiometabolic and Organ System Monitoring
10 Acute Complications
Hypoglycemia Hyperglycemia, DKA, and HHS
11 Chronic Complications
Screening Schedules and Microvascular Disease Macrovascular Disease and Lower-Extremity Foot Care Infections, Dental Disease, Sexual Dysfunction, and Other Comorbidities
12 Special Situations & Populations
Sick-Day Management, Surgery, Travel & Emergency Preparedness Special Populations Across the Lifespan Preconception, Pregnancy, Postpartum & Gestational Diabetes Daily Living, Psychosocial Wellbeing & Safety
13 Evaluation & Documentation
Evaluating Intervention Effectiveness & Outcomes Documentation, Plan Revision & Referral
14 Standards, Guidelines & Professional Practice
National Standards for DSMES and the National DPP Applying Evidence-Based Practice Guidelines Population Health, Health Equity & Advocacy
Assessing Learning: Goals, Readiness to Change & Literacy
Key Takeaways Explain This Topic AI
Domain I.C (Learning) is worth 10 of the 37 scored Assessment items and covers learner goals, readiness to change, preferred learning styles, and literacy.
The Transtheoretical Model's five stages of change — precontemplation, contemplation, preparation, action, and maintenance — describe a person's readiness to change behavior and should guide the intensity and framing of education.
Health literacy is the ability to obtain, process, and understand basic health information needed to make appropriate decisions; low health literacy is common and often invisible without direct assessment.
Numeracy — the ability to work with numbers such as carbohydrate grams, insulin units, and glucose values — is a distinct skill from general literacy and must be assessed separately.
Digital literacy assessment determines whether a person can use portals, apps, and connected devices, which increasingly gate access to modern diabetes technology and telehealth.
Last updated: July 2026
Why Assess Learning Separately From Behavior
Domain I.C — Learning — is a distinct 10-item sub-area from I.B's behavioral assessment. Where I.B asks "what does this person do," I.C asks "how ready and able is this person to learn something new." A technically accurate education plan fails if it is delivered before the person is ready to change, in a style that doesn't match how they learn, or at a literacy level they cannot access. This section covers four learning-assessment components: learner goals and needs, readiness to change, learning styles, and literacy (health literacy, numeracy, and digital literacy).
Assessing Goals and Needs of the Learner
Effective assessment starts by asking the person what they want to learn or achieve, not only what the DCES believes they need. A useful opening question is simply: "What matters most to you right now about your diabetes?" The answer might be symptom relief, avoiding complications, satisfying a family member, or maintaining independence — and that stated priority should shape which topics are taught first, even when clinical urgency suggests a different order. Aligning education with the learner's own goals improves engagement and retention far more than a rigid, clinician-driven curriculum, and it also builds the collaborative relationship that the individualized education plan in Chapter 5 depends on.
Assessing Readiness to Change: The Stages of Change
The Transtheoretical Model (Stages of Change) is the standard framework for assessing behavioral readiness and is directly testable content:
- Stage Description Assessment Cue
- Precontemplation Not considering change; may not see a problem "I don't really think my diet needs to change"
- Contemplation Aware of the need, weighing pros/cons, ambivalent "I know I should, but I'm not sure I'm ready"
- Preparation Intends to act soon, may have taken small steps "I've started looking into meal planning"
- Action Actively practicing the new behavior "I've been counting carbs for the last month"
- Maintenance Sustaining the change and preventing relapse "I've kept this up for over six months"
Matching intervention intensity to stage matters: pushing detailed action-oriented teaching (e.g., precise carbohydrate counting) onto someone in precontemplation typically produces resistance, while someone in the action or maintenance stage benefits from relapse-prevention and troubleshooting support rather than basic motivation-building. A person's stage can also differ across behaviors at the same visit — someone may be in maintenance for glucose monitoring but precontemplation for increasing physical activity — so readiness should be assessed per behavior, not as a single global rating.
Assessing Preferred Learning Styles
Learning-style assessment identifies how a person best absorbs new information — visually (diagrams, charts, printed materials), auditorily (verbal explanation, discussion), through reading/writing (handouts, workbooks), or kinesthetically (hands-on practice, return demonstration). Rather than administering a formal instrument for every learner, the DCES typically asks directly: "When you're learning something new, what works best for you — seeing it written out, having someone walk you through it, or trying it yourself?" Many people benefit from a blended approach, and skills like injection technique or glucose-meter use should always include a hands-on, return-demonstration component regardless of stated preference, since psychomotor skills require practice to assess true competence.
Assessing Literacy: Health, Numeracy, and Digital
Literacy assessment has three interconnected but distinct components:
Health literacy is the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low health literacy is common, cuts across education levels, and is frequently invisible — people with limited health literacy often develop effective coping strategies (deferring to a family member, avoiding written materials) that mask the gap unless specifically screened for.
Numeracy is the ability to work with numbers in a health context — carbohydrate grams, insulin units, glucose values, dosing ratios. Numeracy is a distinct skill from general reading literacy; a person can read fluently and still struggle to calculate an insulin-to-carbohydrate ratio or interpret a sliding scale.
Digital literacy is the ability to use technology tools — patient portals, glucose-data apps, telehealth platforms — that increasingly gate access to modern diabetes care and technology.
Rather than relying on educational attainment as a proxy, brief teach-back ("Can you tell me in your own words how you'd use this information?") and direct observation of a calculation or device task are more reliable screens than assumptions based on how articulate a person sounds in conversation. Teach-back should be used routinely, not only when low literacy is suspected, since it also catches misunderstandings in learners who present as highly literate but have absorbed the wrong detail.
Bringing Learning Assessment Into the Plan
The findings from this section feed directly into Chapter 5's individualized education plan: stage of change shapes pacing and intensity, learning style shapes delivery method, and literacy findings shape material complexity and format (plain-language, teach-back-verified, or visual-first). Skipping learning assessment and delivering a one-size-fits-all curriculum is a common cause of education that is technically correct but practically ineffective. A short, repeatable learning assessment at the start of every encounter — not just at the initial visit — also catches drift over time, since stage of change can regress after a life stressor and literacy needs can shift after a cognitive or vision change that the person may not think to mention unprompted.