Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8300, USA.
J Health Commun. 2010;15 Suppl 2(Suppl 2):146-58. doi: 10.1080/10810730.2010.499980.
The mechanisms underlying the relationship between health literacy, numeracy, and glycemic control are unclear. We explored the role of diabetes self-efficacy in the predicted pathway linking health literacy and numeracy to glycemic control (A1C). Adults with type 1 or type 2 diabetes mellitus (N = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included demographic information, health literacy, general numeracy, and A1C. Path models estimated relations among health literacy, numeracy, and diabetes self-efficacy as predictors of A1C. Health literacy (r = 0.14, p < .01) and numeracy (r = 0.17, p < .001) were each associated with greater diabetes self-efficacy, and greater diabetes self-efficacy was associated with lower A1C levels (r = -0.25, p < .001). When considered in combination, numeracy was related to diabetes self-efficacy (r = 0.13, p < .05), and the effect of health literacy on diabetes self-efficacy was reduced to non-significance (r = 0.06, p = .30). Health literacy and numeracy are each associated with greater diabetes self-efficacy, and greater diabetes self-efficacy is associated with lower A1C levels. Diabetes self-efficacy may be an important target of interventions to improve diabetes control and promote health equity related to health literacy and general numeracy skills needed for diabetes management.
健康素养、计算能力与血糖控制之间关系的潜在机制尚不清楚。我们探讨了糖尿病自我效能在健康素养和计算能力与血糖控制（糖化血红蛋白，A1C）之间预测路径中的作用。在三个医疗中心的基层医疗和糖尿病诊所进行的横断面研究中纳入了 1 型或 2 型糖尿病成人（N=383）。收集的数据包括人口统计学信息、健康素养、一般计算能力和 A1C。路径模型估计了健康素养、计算能力和糖尿病自我效能作为 A1C 预测因子之间的关系。健康素养（r=0.14，p<.01）和计算能力（r=0.17，p<.001）均与更高的糖尿病自我效能相关，而更高的糖尿病自我效能与更低的 A1C 水平相关（r=-0.25，p<.001）。当综合考虑时，计算能力与糖尿病自我效能相关（r=0.13，p<.05），而健康素养对糖尿病自我效能的影响则降至无统计学意义（r=0.06，p=0.30）。健康素养和计算能力均与更高的糖尿病自我效能相关，而更高的糖尿病自我效能与更低的 A1C 水平相关。糖尿病自我效能可能是改善糖尿病控制和促进与管理糖尿病所需的健康素养和一般计算能力相关的健康公平的干预措施的重要目标。
