Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Diabetes Technol Ther. 2010 Nov;12(11):913-9. doi: 10.1089/dia.2010.0058. Epub 2010 Sep 30.
Although limited health literacy is a barrier to disease management and has been associated with poor glycemic control, the mechanisms underlying the relationships between health literacy and diabetes outcomes are unknown. We examined the relationships between health literacy, determinants of diabetes self-care, and glycemic control in adults with type 2 diabetes.
Patients with diabetes were recruited from an outpatient primary care clinic. We collected information on demographics, health literacy, diabetes knowledge, diabetes fatalism, social support, and diabetes self-care, and hemoglobin A1c values were extracted from the medical record. Structural equation models tested the predicted pathways linking health literacy to diabetes self-care and glycemic control.
No direct relationship was observed between health literacy and diabetes self-care or glycemic control. Health literacy had a direct effect on social support (r = -0.20, P < 0.05) and through social support had an indirect effect on diabetes self-care (r = -0.07) and on glycemic control (r = -0.01). More diabetes knowledge (r = 0.22, P < 0.05), less fatalism (r = -0.22, P < 0.05), and more social support (r = 0.27, P < 0.01) were independent, direct predictors of diabetes self-care and through self-care were related to glycemic control (r = -0.20, P < 0.05).
Our findings suggest health literacy has an indirect effect on diabetes self-care and glycemic control through its association with social support. This suggests that for patients with limited health literacy, enhancing social support would facilitate diabetes self-care and improved glycemic control.
尽管有限的健康素养是疾病管理的障碍，并与血糖控制不佳有关，但健康素养与糖尿病结局之间关系的机制尚不清楚。我们研究了健康素养、糖尿病自我护理的决定因素与 2 型糖尿病成人血糖控制之间的关系。
从一个门诊初级保健诊所招募了糖尿病患者。我们收集了有关人口统计学、健康素养、糖尿病知识、糖尿病宿命论、社会支持和糖尿病自我护理的信息，并且从病历中提取了血红蛋白 A1c 值。结构方程模型测试了将健康素养与糖尿病自我护理和血糖控制联系起来的预测途径。
健康素养与糖尿病自我护理或血糖控制之间没有直接关系。健康素养对社会支持有直接影响（r=-0.20，P<0.05），并且通过社会支持对糖尿病自我护理（r=-0.07）和血糖控制（r=-0.01）有间接影响。更多的糖尿病知识（r=0.22，P<0.05）、更少的宿命论（r=-0.22，P<0.05）和更多的社会支持（r=0.27，P<0.01）是糖尿病自我护理的独立、直接预测因素，并且通过自我护理与血糖控制相关（r=-0.20，P<0.05）。
我们的研究结果表明，健康素养通过与社会支持的关联对糖尿病自我护理和血糖控制有间接影响。这表明对于健康素养有限的患者，增强社会支持将有助于糖尿病自我护理和改善血糖控制。
