Schillinger Dean, Barton Lauren R, Karter Andrew J, Wang Frances, Adler Nancy
Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.
Public Health Rep. 2006 May-Jun;121(3):245-54. doi: 10.1177/003335490612100305.
We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients.
We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in 395 diabetes patients at a U.S. public hospital. We performed path analysis to compare two competing models to explain glycemic control. The direct effects model estimated how education was related to HbA1c; the mediational model estimated the strength of the direct relationship when the additional pathway from education to literacy to HbA1c was added.
Both the model with a direct effect of education on HbA1c and the model with literacy as a mediator were supported by good fit to observed data. The mediational model, however, was a significant improvement, with the additional path from literacy to HbA1c reducing the discrepancy from observed data (p < 0.01). After including this path, the direct relationship between education and HbA1c fell to a non-significant threshold.
In a low-income population with diabetes, literacy mediated the relationship between education and glycemic control. This finding has important implications for both education and health policy.
我们试图确定在糖尿病患者中，读写能力是否介导了教育与血糖控制之间的关系。
我们在美国一家公立医院对395名糖尿病患者测量了教育程度、使用成人功能性健康读写能力简短测试（s-TOFHLA）评估的读写能力以及血糖控制情况（糖化血红蛋白）。我们进行路径分析以比较两个相互竞争的模型来解释血糖控制情况。直接效应模型估计教育与糖化血红蛋白之间的关系；中介模型估计当加入从教育到读写能力再到糖化血红蛋白的额外路径时直接关系的强度。
教育对糖化血红蛋白有直接影响的模型和以读写能力作为中介的模型均与观察数据拟合良好。然而，中介模型有显著改进，从读写能力到糖化血红蛋白的额外路径减少了与观察数据的差异（p < 0.01）。纳入这条路径后，教育与糖化血红蛋白之间的直接关系降至不显著水平。
在低收入糖尿病患者群体中，读写能力介导了教育与血糖控制之间的关系。这一发现对教育和卫生政策都具有重要意义。
