Associations Between Health Literacy, Diabetes Knowledge, Self-Care Behaviors, and Glycemic Control in a Low Income Population with Type 2 Diabetes

Abstract

Objective: This study assessed associations among health literacy, diabetes knowledge, self-care, and glycemic control in a low income, predominately minority population with type 2 diabetes. Methods: One hundred twenty-five adults with diabetes were recruited from a primary care clinic. Subjects completed validated surveys to measure health literacy, diabetes knowledge, and self-care (medication adherence, diet, exercise, blood sugar testing, and foot care). Hemoglobin A1c values were extracted from the medical record. Spearman's correlation and multiple linear regression were used to assess the relationship among health literacy, diabetes knowledge, self-care, and glycemic control controlling for covariates. Results: Cronbach's a was 0.95 for the Revised Rapid Estimate of Adult Literacy in Medicine. The majority of the sample was <65 years old (50.7%), female (72.5%), and African American (71.4%), had less than a high school education (68.2%) and a household income <$15,000 (64.2%), and reported their health status as worse than last year (73.9%). In adjusted models that examined the associations among health literacy, diabetes knowledge, medication adherence, and self-care, health literacy was only significantly associated with diabetes knowledge (b ¼ 0.55; 95% confidence interval [CI] 0.29, 0.82). In the final adjusted model for independent factors associated with glycemic control, both diabetes knowledge (b ¼ 0.12; 95% CI 0.01, 0.23) and perceived health status (b ¼ 1.14; 95% CI 0.13, 2.16) were significantly associated with glycemic control, whereas health literacy was not associated with glycemic control (b ¼ À0.03; 95% CI À0.19, 0.13). Conclusions: Diabetes knowledge and perceived health status are the most important factors associated with glycemic control in this population. Health literacy appears to exert its influence through diabetes knowledge and is not directly related to self-care or medication adherence.

Levels and Predictors of Adherence to Self-care Behaviour among Adult Type 2 Diabetics at Arba Minch General Hospital, Southern Ethiopia

“…Diabetes self-management strategies increase lifestyle adjustments to maintain best possible diabetes management to achieve optimal glycaemic control in type 2 diabetics [83][84][85][86][87][88][89][90][91]. In this study the current situation of adherence to self-care behaviour of type 2 diabetics in Arba Minch General Hospital and factors that contribute to efficient adherence to self-care behaviour of diabetics was investigated.…”

Glycemic Control and Its Determinants among Patients with type 2 Diabetes Mellitus Attending a Teaching Hospital

“…The finding is similar to the findings of other authors who found that there was no correlation between knowledge [35] and attitude [36] with glycemic control. However, other studies [37][38][39] found that diabetes knowledge, attitude and adherence to health regimens were associated with glycemic control. Lack of relationships among age and gender and poor glycemic control in our study is consistent with Shani et al [40] who found neither age nor gender were related to the achievement of good glycemic control.…”

The impact of health literacy on diabetes self-management education

“…Low HL has been associated with poor health outcomes for many diseases, especially chronic diseases such as diabetes (Berkman, Sheridan, Donahue, Halpern and Crotty, 2011;Martin, Williams, Haskard and DiMatteo, 2005;Sabaté, 2003;Van den Broucke, 2014). Several studies have shown that compared to patients with adequate HL, diabetic patients with low HL have poorer knowledge about their disease and its management (Bains and Egede, 2011;Fransen, von Wagner and Essink-Bot, 2012;Gazmararian, Williams, Peel and Baker, 2003;Powell, Hill and Clancy, 2007;van der Heide et al, 2014), adopt fewer self-management behaviours (Lai, Ishikawa, Kiuchi, Mooppil and Griva, 2013;van der Heide et al, 2014), and have poorer levels of glycaemic control and an increased risk of complications (Schillinger et al, 2002;van der Heide et al, 2014).…”